August 1, 2023 Recent Legal News
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US v Diaconesco
Sentenced
Dr. Eliza Diaconescu of Lake Forest, Illinois, was sentenced to six months in prison and has to pay restitution of $84,000 to Medicare. She had plead guilty to prescribing narcotics to patients without a medical exam and then billing Medicare for the treatment. She also created false paperwork to attempt to cover up her crimes.
US v Hadden
Sentenced
Dr. Robert Hadden was sentenced to 20 years in prison for sexual abuse. He was covicted of enticing victims to cross state line to sexually abuse them. The sentence will probably be contested since it is many times the limit of the federal sentencing guidelines. He also abused women while working for Columbia University Irving Medical Center and New York Presbyterian hospital. They have agreed to pay more than $236 million on civil suits regarding Hadden.
St. Luke's Health System v Bundy, Rodriguez People's
Rights Network freedom Man Press
Verdict
The hospital sued all for harassment and intimidation along with defamation. They won $52 million but will probably not see any of the money. None of the defendants participated in the trial so the decision was a default.
New Jersey v Macburnie
Arrested
Maria Macburnie was arrested for posing as a physician. She treated patients at the Shore Medical Associates in Toms River under a family member's name who did have a medical license. The medical center is now permanently closed, as it should be. Top
US v NextGen Healthcare
Settlement
The EHR company agreed to pay $321 million to settle allegations that they lied about the capabilities of some versions of thei EHRs and paid some organizations to purchase their EHR. This was a qui tam suit filed by two people at a place that put in the faulty EHR. They will get $5,580,000.
US v Chung
Settlement
Dr. John Chung, a dermatologist with multiple skin clinics in Tennessee and Georgia has agreed to pay $6,600,000 to settle allegations that his clinics submitted false claims for Mohs procedures. They billed as if all parts of the procedures including the pathology was done by Dr, Chung but in fact others also did part of the procedures. They also misbilled for multiple procedures performed the same day. This was a qui tam and the whistleblower will get $1.32 million.
US v Clarke
Sentenced
Ian Clarke of Knoxville, Tennessee, was sentenced to 24 months in prison and ordered to repay $411,963 plus a fine of $44,258. He had plead guilty to paying kickbacks to co conspirators for signed orders for DME. He was in charge of TN Premier Care, a DME company.
BNSF Railways v Center for
Asbestos Related Disease
Verdict
A judge ruled that the clinic must pay the feds $6 million in damages and penalties for filing false claims which made people eligible for federal programs they should not have eligible for. BNSF got 25% of the proceeds.
US v Sparrow Medical Group
Settlement
The Lansing, Michigan, medical group will pay $671,000 to settle allegations that they billed for incident to charges for a mid level when the criteria were not met. This is a qui tam by a physician in the group.
US v Francis Laguttuta, Lags
Medical Centers
Settlement
The California pain management group agreed to pay $11.4 million to settle allegations that they billed for medically unnecessary tests and procedures. The clinics closed abruptly in 2021 leaving about 20,000 people without access to their medical records. The claims were for skin biopsies, spinal cord stimulation procedures urine drug tests and others. This is a qui tam and the former operations director will get over $2 million. Lagattuta is barred from fed med for five years. The skin biopsies were read by a non medical person.
US v Chisti, C Care LLC, Badiyan,
Psych Care Consultants LLC
Settlement
Dr. Imaran Chisti and his practice in
chesterfield, Missouri agreed to pay $124,504 to settle allegations that they
received money to order tests from the American Institute of Toxicology in
Denton, Texas and RealLab in Dallas. He also got money for ordering tests
from Genesis Reference Laboratory in Orlando, Florida and RDx Bioscience in New
Jersey.
Dr. Shamim Badiyan of Fisco, Texas, agreed to pay $182,676 to settle allegations
that he ws paid money for ordering medical tests from RCx and Genesis.
Psych Care Consultants of St. Louis, Missouri,has agreed to pay $217,430 to
settle allegations that they received money for ordering lab tests from Genesis
and InHealth.
US v Greager,II, Cancer Therapy
Associates
Settlement
Dr. John Graeger II and his practice willpay $750,000 to settle allegations that he/they lied about dates to remove moles in order to get money. This was a qui tam suit. Greager also was criminally prosecuted and got a six month sentence.
US v Sagger, Barringer
Arrested
Dr. Sonny Sagger who owned multiple urgent care centers in St. Louis and his office manager Renita Barringer were arrested for health care fraud. They are accused of conspiring to make false statements by billing for services provided by mid level practitioners as if the physician had provided the services. These were assistant physicians who were medical school graduates who had not gotten residencies. They were supposed to receive training while being supervised by a physician, they received no training. Top
Epic v Tata Consultancy Services
7th
Several years ago Epic won $940 million in a suit against the Indian company for trade secret issues. This was later reduced by $500 million to comply iwth local law. Then is was reduced again to $140 million in compensatory and $420 million in punis. The court ruled it would not change the $140 million compensatory damage.
California Medical Association v Aetna
California Supreme Court
The high court ruled that the CMA has standing to sue the insurer over the threat to physicians who refer out of network. This overturned an appellate ruling that said no standing since no contractual arrangement between the two.
Erny v California
Filed
Sarah Erny, a nurse practitioner with a doctorate, was earlier found guilty of using the work doctor. Now three other nurse practitioners with doctorates are suing to be able to use the word doctor in their title. I have mixed feeling about this. I use the term doctor and do not like when others use it erroneously. However, these people worked for their doctorate degree and also deserve the title as long as it it not confused with medical doctor. When educators use the term doctor. which is proper, they are not confused with medical doctors but these nurses may be.
US v Napoleon
Sentenced
Johanah Napoleon, the former president of the Palm Beach School of Nursing was sentenced to 21 months in prison and ordered to repay $3.5 million. She is a former licensed chiropractic assistant and later was the nursing school owner. She plead guilty to fraud in the great nursing school fraud in South Florida. She has already paid most of the money owed with the sale of several real estate properties.
Santa Clara County v Superior Court
California Supreme Court
Doctors medical center of Modesto and Doctors Medical Center of Manteca provided medical care to three patients enrolled in a county medical plan. There was no contract between the county and the hospitals. The county refused to pay the full amount billed for the emergency room services and the hospitals sued the county. The trial court ruled for the hospitals on a demurrer and the court of appeal overruled and said the county was immune from suit. The Supreme Court reversed. The Claims Act only immunize the county from paying claims due to torts not reimbursement for services. To trial.
Patients v Cigna
Filed
A class action suit has been filed against the insurer for using an algorithm to review and reject claims instead of an investigation into each claim. It is alleged they relied on the notorious PxDx algorithm. Top
Patients v Henry Ford Health
To Be Filed
In yet another hack of a medical EMR without proper security 168,000 patients had their medical and financial data breached. When will these organizations learn to beef up security before and after an attack?
Patients v HCA
Filed
At least five suits have been filed against HCA for their massive data breach. A hacker stole information from an external storage location and posted it online. Top
Malpractice
Quishenberry v United Healthcare
California Supreme Court
Quishenberry sued United for the deth of his father who he believed was discharged prematurely from a skilled nursing facility. The father was a member of a Medicare HMO. He lost in all three courts, trial, appeal and Supreme. The Medicare Part C is preemptive and it says that benefit decisions are not allowed to be litigated not so with treatment decisions. Top
Cunningham v Provost of the
University of Kentucky
Denial of Summary Judgment
Dr. Larry Cunningham was employed by UK as a medical doctor and as an oral surgeon. Cunningham altered medical records to look like he did treatments and not residents. After an investigation a termination of a tenured faculty member was initiated. Cunningham sued on the usual charges including defamation. The University moved for summary judgment. Cunningham alleged that false statements were that he stole, that he took credit for patient care services when performed by a resident, he caused the College of Dentistry to file false claims and that he encouraged another doctor to change medical records as well. Cunningham presented enough evidence for claim #1. This is the only charge to go forward. 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.