December 15, 2007 Recent Legal News
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Policyholders v Blue Shield of CA
CA Ct App
The appeals court allowed a class action suit against California Blue Shield for its discriminatory canceling of policies after members submitted their claims. The ruling was unanimous. The three judge court stated the actions were flatly prohibited. The policy holders will now sue to get their policies reinstated and for all monies paid our for the illegal cancellations.
Physicians v Highmark
Settlement
The settlement between the physicians of the United States and the insurance companies may cost Highmark Insurance up to $14 million. This is a small amount compared to what the big insurers have paid. Highmark will pay $10 million into the fund plus the physician's attorneys fees which may be as high as an additional $4 million. They also had to pay their own attorneys. Don't you feel sorry for the companies? I certainly don't.
Health Net v Wayne Surgical Ctr
NJ Superior Ct
In a terrible ruling a judge ruled that surgeons could not refer to surgical centers in which they had invested. There is in New Jersey, an old rule called the Codey Act that prohibits the referrals. The case started with Health Net not paying for surgeries done at the surgical center since it was out of network. They lost that part of the case. The case also was about the ASC not collecting co-pays. The court stated that patients had an obligation to pay but the ASC did not have to collect. The ruling goes against all other rules that state the surgical center is an extension of the physician's office.
SEC v McGuire
Settlement
UnitedHealth's former CEO William McGuire in a settlement agreement repaid $6 million in stock options as well as pay the SEC and the stockholder a total of $620 million. This is part of the backdating fraud.
US v Blue Cross
Settlement
Blue Cross of Rhode Island settled with the US and State to pay $20 million for their role in illegal payments to corrupt politicians. This gets the company off the hook for criminal charges but not the individuals who participated in the fraud. The money must be p[aid from operating funds and not raised by increasing rates to its policy holders. This week several executives of Blue Cross and several lobbyists were let go.
HealthSouth was referred patients by two orthopedic surgeons in their ASC. The Birmingham, Alabama, Orthopods Lawrence Lemak and James Andrews were given kickbacks for their referrals. HealthSouth agreed to pay the government $14.8 million for that fiasco and another one with physicians in the LA area. The pods had to pay $700,000 to the feds. I don't know what will happen to their Medicare status. Top
Robinson v Bell
Ill.
In a current trial in Springfield, Illinois Mr. Robinson is suing Dr. Stephen Bell, a pathologist for an erroneous diagnosis that led to significant harm to the patient. The kicker in the case is that Dr. Bell made the right diagnosis but on the wrong patient. The hospital employee who prepares the slides misnamed the slide. The hospital has already settled and the only one left standing is the pathologist. An interesting question?
Coombes v Florio
Mass Supreme Ct.
The Court came into line with the other states in that a physician has third party liability for not giving informed consent. A child was killed in an auto accident when a patient of the physician on multiple meds fell asleep and caused an accident. The doctor had not warned the patient about sleepiness with the meds. Top
Cincotta v CEPMC
Filed
The patient filed a class action suit against the California Emergency Physicians Medical Group (CEP America) for charging "list" prices to an uninsured patient for medical fees. This is higher than the negotiated insured prices would have been. The attorney is the same attorney who has sued hospitals for the same thing. The hospitals settled rather than fight the charges in court and face the PR nightmare. It is proper to charge usual and customary charges unless one has a contract with an insurer to charge a different price.
Yadav v Cleveland Clinic
Filed
Dr. Yadav, the head of the vascular intervention section of the Clinic was fired for not disclosing financial conflict of interests. He is suing for discrimination since others at the Clinic did the same thing and were not terminated. I think that they all should have been terminated and the Clinic should have paid alot in severance pay for looking the other way. Top
Randi v Long Island SurgiCenter
NY App Ct
The patient had an abortion at the clinic in 1999, pre-HIPAA. The patient told the staff to contact her via cell phone but of course the staff called her house and talked to her mother. The court found this was not intentional but grossly negligent therefore OK for punitive damages. The jury awarded $65,000 for emotional distress and an additional $300,000 for punitive damages. 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.