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California v Dureo-Carvajal
Arrested
A San Jose male was arrested for posing as a physician as well as sexual battery. This was for doing exams on one patient.
Arizona v Nunez
Sentenced
Gustavo Nunez had plead guilty to 29 felony charges for illegal lipo between 2012 and 2014. He is not a physician. He now has been sentenced to over 38 years in prison. Top
US v Atlantic Pain Clinic
Settlement
The Clinic and its owner Dr. Timothy Dembowski have agreed to pay $250,000 to settle claims that it billed for claims for a physician banned by Medicare along with the use of foreign meds not approved by the FDA. The Clinic lied on their billings stating another physician did the patient care rendered by the banned physician.
US v Navicent Health
Settlement
The Georgia medical center paid the feds $2.5 million to settle accusations that they billed the feds for ambulance trips medically unnecessary or inflated. The whistleblower case was from an ambulance driver who is suing for wrongful termination after questioning the billing practices.
US v Norbergs
Sentenced
Dr. D. Anda Norbergs of Palm Harbor, Florida, was sentenced to six years in prison for ordering, receiving and selling along with billing for illegally imported drugs. The oncologist used several foreign sellers and one did not sell a drug with the necessary ingredient. She also must repay $848,671.
US v Kazeem
Guilty
A jury convicted Emmanuel Kazeem of mail and wire fraud for obtaining over 125,000 stolen identities for a tax fraud scheme. He purchased most from a Vietnamese hacker who got them from an Oregon's company database.
US v Roy
Sentenced
Dr. Jacques Roy of Dallas was sentenced to 420 months in prison for healthcare fraud. He was convicted of falsely certifying home health treatment plans as part of a multimillion dollar scam.
Schultz v CVS
Filed
Megan Schultz from California has filed a class action suit against CVS for overbilling patients. She paid $166 for a med under insurance when the true price was only $92 if she paid cash. She is accusing CVS or collusion with PBMs to raise prices. What happens is the pharmacy gets the cash price and the PBM gets the clawback or difference. The pharmacy is under contract not to tell the consumer there is a better price for the drug. Top
Congress v HHS
DC Ct App
The DC Court is allowing the Democratic state Attorney Generals to intervene in the case. this is a major problem if President Trump wanted to not defend the original suit regarding subsidies. The Dems are using saber rattling to defend their position without the need to.
Alexander v Price
D Conn
Plaintiffs had their class action status returned in the case against Medicare for not allowing administrative appeals for being placed on "observation" status instead of hospital admission. At present an administrative appeal is not possible under Medicare rules.
Hospitals v US
9th Circuit
The court ruled that the feds acted wrongly in approving California's 10% cut of fees to MediCal for hospital outpatient care. The evidence showed that this deprived recipients of access to the same services as others. Top
Patients v University of Vermont
To Be Filed
An employee screwed up and allowed a phishing incident to occur. This affected 2,300 people. They are NOW implementing additional security measures and doing training.
Atlas v CareFirst
DC Circuit Ct
CareFirst was sued in a class action over a 2014 security breach that obtained the PMI of the 1.1 million patients. In a motion to dismiss the district court dismissed the case as it did not involve credit cards or SSNs for identity theft. The Circuit Court reversed saying the people could have identity theft and therefore had a real possibility of damages. Top
Lee Memorial v Male Patient
Filed
Lee Memorial is again suing a patient for not leaving the hospital. They say he is medically ready for discharge but the patient's mother and caretaker will not accept him and he refused to be discharged. He has been there since May 14th and was ready for discharge on June 8. Blue Cross has stopped paying for the patient.
Missouri v Putnam County Memorial
Hospital
To Be Filed
The state auditor has accused the hospital has been part of a $90 million billing scheme. The 15 bed hospital, she alleges, acted as a shell organization to funnel insurance payments to a lab company. Top
Thompson v Portland Adventist
Medical Center
Filed
The woman has sued the hospital after she accidentally suffocated her own child. After giving birth and while under the influence of narcotics and sleep aids was given her child to breast feed. The mother was left unattended for the feeding and about an hour later the child was unresponsive. This will never make trial. Top
Bonni v St. Joseph Health System
Ca Ct App
Plaintiff is a surgeon at St. Joseph and Mission Hospitals. He does robotic surgery and complained many times about the lack of financial and personnel support for robotic cases. He documented multiple episodes of problems of the hospital systems. The hospital found some cases against him and did peer review to get him out. The cases were also reviewed by the plaintiff's expert, who were above reproach, and found to be all within the standard of care. He sued the hospital for retaliation under the state whistleblower law. The hospital responded with a motion for SLAPP which the lower court granted. The court of appeals reversed because the plaintiffs case was not due to the peer review but for retaliation for whistleblowing, a cause of action that is almost never ripe for SLAPP.
Hereford v Norton Healthcare
Ky Ct App
Plaintiff is a nurse at Audubon Hospital and was accused of a HIPAA violation and fired. During a cardiac examination and behind a curtain with other people in the room she told the physicians that they had better wear gloves as the patient had hepatitis. The lower court upheld the firing as did the court of appeals. She did do a HIPAA violation which was meant to protect patients not employees.
EEOC v Mission Hospital
WD North Carolina
A judge ruled that the case will go to trial. The workers claim the hospital fired them after they refuses to have flu shots due to their religious beliefs and whether the workers missed deadlines for requesting religious exemptions. 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.