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US v Gervais
Guilty
Isabel Gervais of Birmingham, Alabama, was also known as Dr. Rose Starr, a naturopathic doctor. She plead guilty of defrauding the public as she had no medical training. She agreed to forfeit $108,000 as proceeds illegally obtained. For the past 15 years she operated various clinics using the above alias and Debra Lynn Goodman.
California v Elkus
Charged Murder
My field, Urology, is dangerous. Stanwood Elkus of Lake Elsinore shot and killed Dr. Ronald Gilbert of the Newport Beach VA. Dr. Gilbert had done prostate surgery on Elkus 19 years earlier. Elkins blamed Gilbert for all of his woes since including incontinence, impotence and losing his girl friend. He shot him 10 times after making an appointment with him under an assumed name. He has plead not guilty by reason of insanity. Top
US v Hesson
Sentenced
Clinical psychologists Rodney Hesson and Gertrude Parker both of Slidell, Louisiana were sentenced to 180 month and 84 months in jail respectively for health care fraud. They were convicted of billing for testing the nursing home residents did not need. The sentencing included the forfeiture of Hesson's home, $525,629 in seized money and a restitution of $13,800,553 by Hesson and $7,313,375 by Parker.
US v Fernandez
Guilty
Dr. Roberto Fernandez of Miami plead guilty of health care fraud. He referred Medicare patients to pharmacies for kickbacks. The drugs were not medically necessary.
US v Fuentes
Guilty
Dr. Edwin Fuentes of Danville, Virginia, plead guilty of healthcare fraud and tax evasion. The GP billed for services not provided and for preventative counseling (double billing). He also did not pay tax on diverted funds.
US v Rall
Guilty
Drs. Kenneth Rall and Michael Richards, both of the University of Missouri, plead guilty to health care fraud for signing radiology reports performed by residents without actually reviewing the radiographs. They then allowed the billing to go forward illegally.
US v Celgene
Settlement
The company agreed to pay $280 million to settle charges that it promoted drugs for uses that had not been approved. They were also accused of paying kickbacks to physicians to use the drugs. This is a whistleblower case by a sales manager for Celgene. She will get many millions of dollars for this case.
US v Pain Management Group
Settlement
Pain Management Group, PC in Antioch, Tennessee, agreed to pay $312,000 to settle allegations that it submitted claims for unnecessary urine drug tests. They also billed for medications obtained from foreign sources and were not FDA approved.
US v Norman
Settlement
Dr. James Norman of Tampa agreed to pay $4 million to settle allegations that he bilked patients by charging them illegally for services for which he had already been paid. This is also a whistleblower case filed by a former patient and her husband, a physician.
US v Parsons
Sentenced
Mollie Parsons of Middletown, Ohio, was sentenced to 36 months in prison for fraud. she had previously been sentenced to ten years in prison for the death of a minor patient. She was a home health nurse for the minor with severe impairments. She was paid for 8 hour shifts but often left the child unattended for hours at a time.
US v Vanderbilt University Medical Center
The hospital has agreed to pay $6.5 million to settle allegations of false billing. The case was by three whistleblowers, anesthesiologists.
US v Blanco
Filed
Bertha Blanco, a Florida healthcare administrator at the Florida Agency for Health Care Administration, has been accused of tipping off a wealthy businessman Philip Esformes who owns dozens of Miami Dade nursing homes when there are violations. He could then fix them prior to being fined or cited. He allegedly paid her mucho dinero for this information. Esformes is being held in federal detention for fraud. Top
Patients v Anthem
To Be Filed
Again Anthem had a data breach. This time it affected 18,000 patients. It occurred last July and one year later they are notifying patients. This was from an employee of a third party vendor emailing himself a file with the information of over 18,000 patients. Last month Anthem paid a fine of $115 million for a 2015 breach that divulged the information of 80 million people.
Patients v Methodist Le Bonhur
Health
Filed
A suit was filed against the above hospital and Saint Francis Hospital of Memphis for balance billing. It is alleged that the hospitals bill patients after being paid the discounted insurance payments. This suit was filed in state court after a federal suit alleging the same was dismissed for administrative non-exhaustion.
Aetna Life v Huntington Valley
Surgery Center
3rd Circuit
Teh Court said there is an issue to be resolved. Whether Aetna paid too much due to the surgery center stating the chargemaster fees were the total fees and not telling about patient writeoffs. The center is accused of routinely waiving the patient co-pays and deductibles and billing for the full charges. I see a settlement in the near future.
US v Aurora Health
Settlement
The company paid $30,000 to complainant number 1, $15,000 to complainant number 2 and a fine of $15,000 for allegations that it discriminated against patients with HIV. Top
Evans v Scanson
Montana Supreme Court
The state high court ruled the jury verdict denying damages was correct. The plaintiff wanted money for the defendant not informing her that the prenatal testing didn't cover CF, which her child was born with. The plaintiff's attorney made a fatal error. He introduced evidence regarding insurance and when the defense also entered insurance information to rebut the court found his objection to the evidence was rightly overturned.
Mitchell v AbbVie
Guilty
Mitchell of Oregon sued AbbVie for misleading his physician and him regarding AndroGel's ability to cause blood clots which may lead to fatal heart attacks. The $150 million punitive damage award will never stand since the jury awarded no compensation for injuries.
Bigler v Olympus
Guilty
Bigler died after an infection caused by an infection from an Olympus duodenoscope. The family sued Olympus and the suit was later joined by Virginia Mason Hospital in Seattle. The jury awarded the hospital $6 million and ordered them to pay $1 million of it to the Bigler family. The company still won the suit, however. The jury did not find the scope to be of faulty design and that it did not per se contribute to the death. The company did not provide adequate warnings or instructions for its use. The jury thought Virginia Mason deserved $25 million but reduced their damages for their complicity.
Borum v Smith
WD Kentucky
In this federal trial the court said that the plaintiff could access the hospital EMR to prove medical malpractice. The family of the deceased Borum was prescribed antidepressants by a physician employed by Deaconess Hospital. The plaintiff wanted to inspect the EMR record and not the paper record generated by the hospital. They also wanted to generate a test patient to see the functionality of the EMR. The court allowed the former but denied the latter. The court went right through the defenses by the hospital of HIPAA and copyright protection. The court also said the hospital needed to provide the meta data and audit trail information concerning the patient but is not required to have the EMR available during the deposition of the physician.
Hopkins v Valley Convalescent
Hospital
Filed
One week after being fined by the state of California $100,000 and given a Class AA citation the hospital has been sued by a patient that died after nine falls at the hospital. The fall that killed him was from his bed with the side roils down. The hospital is also accused of allowing him to get bedsores by not rotating him often enough. He was a diabetic with a leg amputation. Top
Sharda v Sunrise Hospital
D Nevada
Dr. Sharda was a member of the radiological oncology staff at the hospital for ten years. He alleges a competitor put roadblocks to his continued membership. He at various times lost his membership for lack of submitting information and regained it when he did submit it. He was not on the staff when a member of the staff told him of a patient of his was now a patient in the hospital. He visited the patient and was arrested for trespassing. He was reported as having resigned while under investigation and sued. He never got a hearing due to the hospital never setting a date. They said it was up to the physician to set the date. The court saw through this sham immediately and ordered the hospital to set a date for the hearing within 21 days of the court hearing. The court threw out the hospital's HCQIA defense since they never offered him a hearing. They denied all of the physician's complaints until after the hearing.
Hawkins v Grinnell Regional
Medical Center
Guilty
Hawkins sued his former boss and the hospital for age discrimination. He had breast cancer and was fired while in remission and replaced by a younger person. Hawkins is 63 and was the lab director from 1985 to 2015 when he was fired. He had taken a leave of absence and returned part time. The hospital told him to retire in 90 days but he was expected to make a full recovery and wanted to remain full time. The jury awarded Hawkins $220,000 in back pay, $2 million for emotional distress and another $2.28 for future emotional distress. This hospital really needs to fire its HR person and Attorney. The hospital says it plans to appeal. Top
Lewis v California Medical Board
California Supreme Court
Dr. Alwin Lewis of Burbank was investigated by the Board for one case and found him OK on that case. However, while looking at the case they also found five other patients that had problems due to prescribing. The Board put him on probation for those and he appealed the state's un-warranted invasion into prescription drug records held by the state repository. The court ruled that patient privacy was not violated and that the warrantless searches are legal. This follows an Oregon federal case that said the DEA did not need a warrant to subpoena the Oregon database. At the same time the state of Rhode Island passed a law allowing warrantless searches of its prescription data base. Over 20 organizations have written tot he Governor to veto the law. The ACLU is even against the law. 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.