US v Nwora
Dr. Emmanuel Nwora has been indicted on 12 counts of healthcare fraud. He ordered vestibular testing at another site without seeing patients or doing follow-up exams. The owner of the other site has also been charged but is flown the coop.
US v Thomas
Dr. Cassandra Thomas of Jackson, Mississippi, was sentenced to 168 months in prison for healthcare fraud. She ran a fraudulent home health service in the area.
US v Scan
Scan Health, a Medicare HMO in California, has agreed to pay $327 million for withholding information. The HMO did not admit anything. The investigators blamed the State of California for the errors which is reasonable knowing how inept they are. There is also another side since a whistleblower will get a bunch of money for Scan's fraud.
US v Los Angeles Doctor's Hospital
(Pacific Health System)
The hospital entered a guilty plea to healthcare fraud for treating homeless people who did not need treatment. The used cappers to get people into the hospital who never needed to be there. They will pay $16.5 million in restitution.
US v Memorial Hixon Hospital
The hospital quickly settled a suit contending the hospital paid physicians and physician groups to send patients to the hospital. This was a self reporting suit. The fine was $1.3 million.
US v Patel
The panel affirmed the health care fraud charge against the Texas cardiologist Mehmood Patel. He was convicted of 51 counts of fraud and sentenced to 10 years in prison plus a $175,000 fine and restitution of $387,511. He was acquitted on 40 other counts of fraud.
States v Johnson and Johnson
J&J agreed to settle the matter of whether or not it had committed consumer fraud in the marketing of Risperdal, an antipsychotic. The FTC said that the marketing was for conditions not approved such as dementia and bipolar disorder in children. The company will pay money to 36 states. The total money for all claims is $181 million. Other states have sued separately and two have won and two have lost. Several other states did not take part in the settlement so they may sue separately. Top
Planned Parenthood v Texas
Texas had passed a law defunding Planned Parenthood. The District Court on a challenge to the law allowed an injunction until the lawsuit was heard at a later date. This was appealed to the 5th Circuit which ruled against the preliminary injunction. Texas has now stated it will in the very near future stop funding Planned Parenthood. This is an interesting case since it goes directly against Federal wishes. The Feds were funding about 90% of the cost of the state's women health program. They have since dropped payment but the state will pick up the program cost without Planned Parenthood.
Physician Hospital of America v Sebelius
The court dismissed the suit since administrative remedies had not been completed prior to suit. The plaintiff had failed to submit the claim to the Secretary, as if that would do any good.
South Carolina v Addo
Ernest Addo of Georgia stole the identity of a physician friend and began practicing in South Carolina in five Agape Senior facilities. He treated over 500 patients with no or minimal medical training. The physician reported his friend and he was found and arrested. It is interesting that he passed the credentialing at the senior facilities. Top
Patients v Cancer Care
A laptop was again stolen. This time from an employee's locked vehicle. The laptop had patient information on 19,000 Cancer Care Group of Indianapolis , Indiana.
Barracks v Barnes Jewish Hosp.
A patient whose information was on a stolen laptop sued in state court for negligence. The hospital attempted to put the case if federal court but failed. The hits keep on coming. Top
Soriano v Neshoba General Hospital
Dr. Soriano was terminated from the staff and then sued. The lower court and now the 5th Circuit agreed that he received a fair hearing. Since his hearings were fair he was barred from suing for money damages under HCQIA.
Thomas v Leighton Emergency
The physician was terminated after he complained about a white nurse doing med mal. He sued for age and race discrimination as well as other state claims. His case was allowed to go forward as he adequately claimed the facts to support his claim.
Lawrence v Schuylkill Med. Ctr.
A female nurse complained of sexual harassment and retaliation. The hospital had hired a known sexual harasser and he did what he was good at, sexual harass. Lawrence complained about the harassment and was then, according to her, retaliated against by having her hours changed. The court said there was no retaliation but there was a hostile work environment. The case therefore survived summary judgment. Top
Patients v St. John Medical Center
An unnamed non-employed physician at the hospital allegedly did unneeded cardiac stents. He has been terminated from the staff of the hospital but is in the throes of an appeal. The hospital had an outside investigation which apparently found 23 instances of stents being placed without indication. This could be real or a Horty Springer type review which wants only the physician to be responsible and not the hospital (See Recent News this edition). The physician is on the staff of another hospital in the Cleveland, Ohio, area which has also done an examination of the physician's work and found no problems. Could this be a witch hunt on St. John's part on an unemployed physician?? Top
DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.