August 15, 2021 Recent Legal News
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US
v Bravo
Sentenced
Brian Bravo of Pembroke Pines, Florida, was sentenced to 42 months in prison for accepting kickbacks to award lucrative contracts. He was a Director at the infamous Broward Heath and admitting getting paid money for awarding contracts. He also has to pay forfeiture of $427,000. Top
US v Abbott
Settlement
Abbott has agreed to pay $160 million to settle allegations that they routinely waived co pays for glucometers, a violation of the Medicare law. The case is a whistleblower. Here the blower is a $15 an hour employee who will receive $28.5 million.
US v Harper and Hill
Sentenced
Nurse Practitioners Janae Harper and Mark Hill were sentenced to 12 and 9 months in prison respectively. Harper was also ordered to pay $4.3 million in restitution and Hill $5 million in restitution. They signed telemedicine orders for braces that were not needed.
US v Shah
Sentenced
Samirkumar Shah, a cardiologist, had been convicted of fraud and then didn't attend his first sentencing hearing. He got the maximum sentence of 78 months in prison. He was also ordered to pay $1.2 million in restitution. He committed fraud by billing for treatments patients didn't need.
US v San Mateo County
Settlement
The California county and its hospital agreed to pay $11.4 million to settle allegations that they billed for non covered inpatient admissions. They admitted patients for social reasons and lack of alternative placements. This was a qui tam case.
US v Ascension Michigan
Settlement
The system agreed to pay $2.8 million to settle allegations that they billed for procedures that were medically unnecessary. A OB/Gyn did radical hysterectomies and chemotherapy that were not medically necessary or not performed. The hospital, after an investigation, self reported this. However, this was a qui tam case and the three whistleblowers will get a total of $532,000.
US v North Georgia Healthcare
Clinic
Settlement
The clinic and its CEO Delaine Hunter agreed to pay $130,000 to settle allegations that they billed for opioid treatments bu a physician thaaat were not medically necessary. The patients were seen by a medial assistant and not the physician nor were the charts reviewed by the physician.
US v Davis
Settlement
Jon Davis, the former CEO of Anesthesia Services in Tennessee, agreed to a permanent ban from federal programs due to presenting claims for medically unnecessary testing and acupuncture procedures.
US v Arriva medical
Settlement
The Tennessee company agreed to pay $160 million to settle allegations that they billed for claims that were not legitimate due to kickbacks to customers. This is a qui tam suit and the claimant will get over $28 million.
US v Harry
Indicted
Craeghan Harry of Highland Beach, florid, was indicted for health fraud. He is the owner of multiple telemedicine companies. He was previously indicted with two others who have plead guilty to fraud. The new indictment raises more charges against Harry.
US v Zulewski, Patel
Settlement
Mark Zulewski and Kaushal Patel along with their owned companies in the Philadelphia area have agreed to pay $250,000 to settle allegations that Patel allowed Zulewski, a once pharmacist who has been convicted of narcotic offenses and prohibited from fed med to fill prescriptions an then bill for those prescriptions.
US v National Spine & Pain
Center
Settlement
The Rockville, Maryland, company agreed to pay $5.1 million to settle allegations that they illegally paid money to physicians under the guise of a clinical research program. The time sheets were fudged by the company.
US v Cornell Scott Hill Health
Corporation
Settlement
The Connecticut FQHC agreed to pay $350,000 to settle allegations that they billed the feds illegally due to their illegal policy of requiring dental work and cleanings to be done on separate days in order to get more money.
US v Navarro, Varona
Sentenced
A judge sentenced Eduardo Navarro of Miami to 46 months in prison and Mayade Varona of Port St. Lucie to 30 months in prison. They were also ordered to pay $2.134 million in restitution. The two worked Tellus Clinical Research and they falsified two clinical trials by fabricating medical records. Top
Allegheny Health v American
Guarantee
Filed
The network is suing its insurer for not paying after the Governor ordered a shut down to nonemergency services.
Lacks v Pharmaceutical Companies
Filed
The descendents of Henrietta Lacks has hired an attorney and filed suit against the pharmaceutical companies that have profited from the cell line of their matriarch. They had filed suit against Johns Hopkins in the past but lost.
US v United Health
Settlement
The company agreed to pay $13.6 million in restitution and fines of an additional $2.1 million to settle allegations that they imposed stricter limits on mental health claims that physical health claims.
Franciscan
The court blocked the Biden administration from requiring gender transition surgeries or abortion. The Democrats continue to push and get beaten by the courts. Top
Patients v Northwell Health
To Be Filed
Long Island Jewish forest Hill's Hospital, a member of Northwell, reported that an employee snooped on medical records for at fourteen months. This illegal scheme to get medical records for auto accidents was not found by the hospital. They do not even know which records were viewed illegally. They are probably grossly negligent. Top
Galuten v Williamson City Hospital
District
6th Circuit
The patient was 94 yeas old when she presented to the ER of the hospital for multiple complaints. She was diagnosed with severe malnutrition and hypernatremia and admitted to the ICU for nine days and then transferred to a nursing home where she died. The executor and the dumb attorney sued under EMTALA. Two expert witnesses attested in discovery that she was stable prior to the transfer and to no one's surprise the case was dismissed. The 6th Circuit agreed despite the ACA claim of age discrimination, a non-winner. Let us hope they lost a lot of money on this case. Top
Baylor Scott and White v
McCullough
Filed
The system has filed suit against Dr. Peter McCullough to enjoin him from using their name. The physician who has "controversial views" about Covid vaccines says he has not claimed to be employed by the system since leaving the system earlier in the year. The press uses the prior association without any encouragement from the physician.
Bonni v St. Joseph Health System
California Supreme Court
Dr. Aram Bonni had patient complications in two successive robotic surgeries and reported safety concerns. He then had peer review. He sued and the hospital plead to strike the retaliation causes under the anti-SLAPP rule as the claims arose from protected peer review activities. The trial court agreed but the Appellate Court overturned and the Supreme Court agreed with the Appellate Court. The court agreed that peer review is a protected activity but it protects only freedom of speech and petitioning activity it does not apply to final disciplinary decisions. The physician could rely on protected statements made during peer review as evidence of the hospital's improper motive for imposing discipline. The court then sent the case back to the trial court to determine if Dr. Bonni had established minimal merit regarding his claims.
Natatajan v Dignity Health
California Supreme Court
Dr. Sundar Natarajan, a hospitalist at St. Joseph Medical Center in Stockton, California, had his privileges revoked due to record keeping problems and not responding when on call. The hospital appointed a lawyer to be the peer review hearing officer. His contract barred the hospital from being appointed a hearing officer for three years. He had been an hearing officer several times prior to this hearing an several time since. The peer review committee adopted the executive committee recommendation and the board agreed. Dr. Natarajan filed a petition for a writ of administrative mandate saying he was denied due privilege as Singer's relationship created a potential for bias and the decision to revoke was not based on objective standards. The trial court agreed with the hospital and the appellate court agreed finding that the attorney had no direct financial interest in the outcome of the proceedings. The Supreme Court said that the prospect of future employment was not categorically non-disqualifying but may be disqualifying based on a direct financial benefit that creates an intolerable risk of actual bias. In determining if a hearing officer is disqualified the court must consider two factors. (1) who controls the hiring process and (2) the extent a likelihood of future financial opportunities for the officer at the same hospital. Here the medical staff or their designee (the hospital) picked the hearing officer and his 3 year limitation did not create an intolerable biased view.
Hartman v Centra Health
WD WVa
Kimberly Hartman was an employed RN and unit manager at a hospital. Hartman found the patient census was low and on investigation she found the intake department denied two children to be transferred with acute psychiatric symptoms. She reported this to her superiors. She, at a meeting, said these were EMTALA violations and was then directed to leave the hospital. The person who directed her to leave then made statement to another organization that Hartman was mentally ill and posed a risk of gun violence. Hartman sued for defamation and blowing the whistle blowing statute. The court agreed with Harman and the case goes forward.
Shahbabian v Trihealth
SD Ohio
Dr. Set Shahbabian, a surgeon at Good Samaritan Hospital, had a contract to for five years at an annual income of $968,000. He had to complete a baseline production of 24,207 RVUs. He had quality concerns and then health issues requiring him to change his surgery scheduling and other changes. When his contract was not renewed he was told he owed $679.711. He sued for breach of contract etc. The hospital argued that the action was protected by peer review immunity under Ohio law and the court agreed. 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.