August 1, 2009 Recent Legal News
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California v Nursing
Arrests
California officers arrested 20 individuals in a Medicaid home health scam. This brings to 42 arrested in this scam. The ringleader pled guilty last year.
US v George
Guilty
Pharmacist Joby George of Greenwich, Connecticut, pled guilty of violation of the False Claims Act. He has been ordered to repay $344,000 in a civil agreement. He will be sentenced later on charges of accepting money for narcotics that were not prescribed and for submitting bills for meds never delivered.
New Jersey v Salartash
Indicted
Dr. Khashayar Salartash, his office manager and his business The Center for Lymphatic Disorders, LLC were all accused for fraud for multiple misrepresentations as well as treating people for much longer than necessary. They are accused of fraudulent billing of $8.5 million.
US v DeCandido
Settlement
Dr. Gabriel DeCandido of Largo, Florida, agreed to pay the US $1.7 million to settle allegations of fraud. The government garnisheed over $900,000 he had transferred to his wife and took his automobiles. This was a whistleblower case and the whistleblower received over $300,000.
US v New York
Settlement
The city and state of New York agreed to repay the feds over $500 million for overcharges. Again, another whistleblower case but this one gets $10 million. This was for allegedly billing for unneeded speech therapy in the 1990s. The state hopes to save an additional $1 Billion by settling the case.
US v Levich
Filed
Simon Levich, DPM, of New York wasn't dumb but plain stupid. He billed Medicare a months worth of work in a single day. He billed for 160 hours of work in a single day. He has also been accused of billing for services never done and done under other doctors names. He is free on a $1 million bail.
US v Physicians
Indicted
The feds have indicted 32 physicians and business people for Medicare fraud. The latest raids were in Louisiana, Boston, New York and Houston. This is a $16 million dollar scam regarding arthritis kits that are billed for $3000 each. Top
Boston Med Ctr v Massachusetts
Filed
The hospital is suing the state for its miserly payments for Medicaid patients. They are now being paid about 64 cents of every dollar expended for the patient and about 10% of their patients are uninsured, even though the Republic has universal care. A legal professor at Northeastern states that this shows that insurance alone does not solve problems and it may even exacerbate the financial problems of safety-net hospitals in the short term.
Indiana Med Assn v WellPoint
Filed
The medical association has filed for mediation which is allowed after the national settlement. The association claims that Anthem, a subsidiary of WellPoint, has underpaid and late paid the state physicians. The problem has been from the computers at Anthem and has gone on for two years. Anthem disputes the charges but will lose.
Berry v Paul Revere
La Ct App
Dr. Berry, an anesthesiologist, was hooked on narcotics. He lost his privileges and his medical licenses. He asked for and received disability insurance payments for about two years and then they stopped since he had been drug free for three years and had no license. He sued stating that if he returned to work he would possibly become hooked again. The trial court ruled on summary judgment for the insurance company. The appeals court said there should be a trial to determine the probability of relapse which was crucial to the determination of disability. Top
California v Kaiser
Fined
Kaiser Bellflower has again been fined in the octomom case. This time for $187,500. The last fine was for $250,000. I wonder if insurance covers this.
DOJ Release
The Department of Justice released a notice stating that one employed doctor and two hospital employees have pled guilty in a criminal misdemeanor violation of HIPAA. The physician has his privileges suspended for two weeks and the two employees were fired. They have not yet been sentenced but face a maximum sentence of one year in jail and/or a fine of up to $50,000 each. Top
Cramer v Fairfield Hosp
Ohio Ct App
When is a fraud not a fraud? When the court says it isn't. The hospital did a summary suspension of a radiologist for disruptive conduct. They then lied to the physician in order to induce him to sign a release. He had never been suspended. The part that is questionable is whether or not the physician knew that he was not suspended when he signed the release.
Straznicky v Desert Springs Hosp.
D Nev
The physician had been suspended for disruptive conduct. He signed an agreement and had his privileges reinstated. Then he resigned. The hospital reported him to the NPDB for resigning while under investigation. The physician thought he was no longer under investigation and so sued. The court ruled for the hospital since the physician did not dispute the report at the data bank prior to suing. This is bogus since the Bank can not except in exceptional circumstances change a report by a hospital. They have the hospital change the report. The hospital was immune from damages under HCQIA.
Benson v St. Joseph
5th Circ
The hospital MEC recommended non-renewal of his privileges. While the peer review was being conducted he sued for the usual state claims and antitrust. The district and appeals court both gave summary judgment to the hospital under the Texas Medical Practice Act. For the antitrust action was also dismissed because he failed to state a cause of action. He showed that there was only one hospital in the county and all insurers required use of that hospital. The court stated that he could treat patients in his own clinic and therefore there was no adverse impact on the OB/GYN in the county. It is amazing that the court reaches a conclusion and then finds a way to justify it. Top
DeBartolo v HealthSouth
5th Circ
The physicians entered a contract with HealthSouth in an ASC. The contract stated the surgeon would do 1/3 of his surgical cases at the ASC. He did not comply and then sued the ASC alleging the provision violated the federal anti-kickback provision. The district court dismissed the suit for failure to state a claim. The 5th also dismissed the suit but for lack of subject matter jurisdiction. It remanded the suit to state court. Top
In the last Update I put in the following item. I received an email correcting the name of the hospital and telling more details.
No Challenge
Dr. Joshua Welch of Fletcher John Health Care was reprimanded by the state medical board for accessing the medical records of eight women illegally since none were his patients. The physician is not practicing currently and is taking courses in physician patient boundaries.
FYI - The correct name of the hospital is Fletcher ALLEN Health Care. Dr. Welch was having an affair with at least one of these women (who was not his patient nor was he involved in any of her medical care), and he accessed her lab results to see if she had STDs. Top
Hereford v U. Michigan Hosp
Not Filed
Mr. Hereford had an intestinal cancer and died postop due to a perforated bowel. The patient's wife was a hospital manager and a nurse, realized the problem but could not get any nurse or physician to order a CT to confirm the diagnosis. When they did do the CT the diagnosis was confirmed but it was too late to save the patient. The hospital sent a canned letter to the wife with no admission of their error. The wife, being a bigger person than the hospital, agreed to tell her story to the hospital personnel so the nurses would begin to talk to patients and relatives and the hospital changed its policies so that the same physician would round on the patients each day.
Airman v US
Can not be Filed
An active duty airman was to have his gallbladder removed at Travis AFB. At the beginning of the laproscopic procedure the aorta was punctured possibly by a second year resident and emergency surgery ensued to suture the vessel. Later he developed bilateral iliac clot and his legs needed to be amputated. His gallbladder is still in place.
Moses v Providence Hosp
6th Circ
The Circuit refused to rehear en banc a prior case concerning a murder of a woman by a patient ten days post discharge from the ED. They had previously ruled that the woman's estate had standing to sue. Only one justice had the law correct when he stated that EMTALA is not a federal med mal statute but is limited to screening and stabilization.
Bubb v Brusky
Wisconsin Supreme Ct
Bubb went to see Dr. Brusky in the ED of St. Agnes Hospital in Fond Du Lac, Wisconsin for a possible stroke. After an examination which had a CT and an EKG and consulting with a neurologist he was diagnosed as a TIA, given ASA and told to see a neurologist. Two days later he had a full stroke due to a almost completely occluded carotid artery. He sued because he was not told he could be admitted and given a doppler ultrasound and he was not told of all his options. The trial court ruled for the physician as did the court of appeals. The state Supreme Court disagreed stating that in order to make a true informed consent the patient needs to know all of their options.
Ruiz v Pedolsky
Ca Ct App
The California Court of Appeal stated that in a malpractice action where the patient had signed an arbitration clause and then died, in the ensuing wrongful death suit the arbitration agreement would not pass on to the wife or the adult children. This is a split of authority in the state. The wife in this case had poor legal advise and agreed that she was bound to the agreement. The physician therefore must either appeal the case to the California Supreme Court to resolve the splits of authority, have the courts decide in one action or have the wife's claim decided in arbitration and the children's decided in court. Top
Jimenez v Martin Memorial
Jury
Martin Memorial Hospital in Florida took care of Jimenez, an illegal alien, after he was hit by a drunk driver and was paralyzed and had severe head injuries. The hospital admitted him and then no one would take him for follow-up care due to his illegal alien status and lack of payments. The hospital put Jimenez on a plane and sent him back to Guatemala. They are now being sued for false imprisonment and for his care the rest of his life in Guatemala. This transfer was with the approval of the Guatemalan government. An appeals court already decided that the state and hospital did not have the authority to deport Jimenez since only the feds can do this. The jury sided with the hospital believing the action was reasonable.
Patients v Rose Hospital
To Be Filed
Rose Hospital in Denver hired a surgical tech by the name of Kristen Parker. While working at the hospital and a surgical center she allegedly stole narcotics, used the needle on herself and then drew up saline with the same needle and syringe and injected the saline into the narcotic bottle. The really bad part is she has Hepatitis C and apparently passed it on to at least 19 patients at Rose. She was tested prior to working at Rose and was equivocally positive for Hep C. The hospital never followed up.
US v St. Joseph Hospital
Settlement
St. Joseph Hospital has finally admitted the investigation into their business relationship with MidAtlantic Cardiovascular Associates. Not only did they now admit the investigation they agreed to settle a suit by the fed in relation to it. Several administrators had already lost their jobs over the relationship and another suit is in the works by Cardiac Surgery Associates against the above two entities to keep them out of the hospital. The details of the settlement will not become public for several months.
DeCarlo v Mt. Sinai
Filed
Ms. DeCarlo, a Catholic nurse at Mt. Sinai Hospital in New York was forced to participate in an abortion which is against her religion. She was apparently told that if she did not participate in the abortion of a 22 week fetus it would be insubordination and patient abandonment. She had told the hospital in her initial interview and later in writing of her objections to abortions. There were other nurses available to work the case but the supervisor apparently refused to call them. The abortion was a Category II, one that needs to be done within six hours not an emergency.
California v Tustin Care Ctr.
Fined
The nursing home was fined $50,000 for not doing an eating ability assessment on a patient. The patient died and the autopsy revealed the esophagus completely blocked. Top
Northwest Hosp v Ark. Gazette
Filed
The hospital sued the paper to enjoin it from running an ad by a local law firm for patients of a physician at the hospital and accusing the hospital of negligent credentialing. The paper is in the same county as the trial will be held potentially contaminating the jury pool. The paper originally was not going to run the ad but a slight change was made and they ran the ad for five days. This is the end of the case where the physician had already settled out and the attorneys are looking for a little more money. The name fits.
Florida v Rodriguez
Indicted
Ruben Rodriguez has been accused of buying medical records from a Jackson Memorial ultrasound tech, Rebecca Garcia for $1000 a month. Rodriguez then contacted the yet to be named attorney in the hopes of representing the people. Rodriguez would then be paid by the shyster a percentage of of the settlements. 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.