December 15, 2018 Recent Legal News
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Michigan v Wells
To Trial
Dr. Eden Wells was ordered by a state judge to stand trial for involuntary manslaughter. She was the state's chief medical executive. She took the post in May 2015 and is charged of failing to alert the public of the spike in Legionnaires Disease in a timely manner and causing the death of John Snyder. She is also accused of obstructing justice and committing misconduct in office. She stats she was not aware of the 2014-15 epidemic until September 2015 and even if she did know she had no legal duty to alert residents. She also states there is no evidence that John Snyder died of Legionnaires' Disease. With a change of administration in the state the charges may be reevaluated. Top
California v Paredes
Convicted
A San Diego jury convicted Gonzalo Paredes, the medical office manager for Advanced Radiology of Beverly Hills. The owner of the company Dr. Ronald Grusd, a radiologist, had been previously convicted and sentenced to ten years in prison. Parades helped negotiate kickbacks for referrals with chiropractors.
US v Craven
Guilty
Candace Craven, NP of Tennessee plead guilty of healthcare fraud. She admitted making sham telemedicine evaluations in order to prescribe compounded meds that were very expensive and not needed. She mainly scammed marines and their families in the San Diego area and TRICARE.
Nebraska v Kwapniowski
Filed
The attorney general has asked the state HHS to take disciplinary action against the former pharmacy director of Children's Hospital for embezzlement. They allege she made up invoices for a make believe drug and stole the money. $4 million worth.
US v Madison
Guilty
A jury has convicted Dr. Paul Madison of Chicago of fraud for billing for nonexistent treatments. He claimed to give anesthesia for chiropractor manipulations that never occurred. He owned Watertower SurgiCenter on North Michigan Ave.
FTC v Dorfman
Filed
The agency says that Simple Health Plans CEO Steven Dorfman bilked thousands into buying worthless health insurance. Dorfman has filed a claim wanting $15,000 per month for living expenses plus $200,000 for legal expenses. Among his expenses are health insurance payments to a real insurance company.
US v Medtronic
Settlement
The compnay has agreed to pay %50.9 million to settle allegations that it illegally marketed devices as wll as kickback allegations against Covidien before it was purchased by Medtronic.
US v Bothra
Indicted
Six Michigan physicians were indicted for healthcare fraud. They are Drs. Rajendra Bothra, Eric Backos, Ganiu Edu, David Lewis Christopher Russo and Ronald Kufner. All worked in the clinic owned by Bothra and allegedly prescribed opioids to induce patients to come to the clinic. Once there the patients had to undergo ancillary services in order to get their prescriptions.
US v Raymond
Guilty
Robert Maglicic, Jr. and Lisa Raymond pleaded guilty of health care fraud. They participated in a scheme with Southern Support to defraud Medicaid. These two execs of the organizations helped fabricate records to support prior billings.
US v Aslam
Guilty
Dr. Zahid Aslam of Delaware pleaded guilty of making a false statement to a financial institution and health care fraud. He lied on a loan application and also billed for procedures done by a PA as if an MD had rendered the service. He agreed to pay $3.07 million to resolve his civil liability and will be sentenced later for the criminal ones. He has given up his medical license and agreed to be excluded from al fed med.
US v Parks
Indicted
A grand jury has indicted Christopher Parks, Dr. Gary Lee and Dr. Jerry Keepers of Tulsa and Kingwood, Texas of violations of the federal anti kickback law. The indictment says that Parks and Lee paid kickbacks to physician to write compounding prescription that were not needed. Keepers was charged with receiving $860,000 in bribes.
US v Sutter Health
Intervenes
The feds have intervened in a whistleblower case against Sutter Health of Sacramento and the Palo Alto Medical Foundation. The allegation is that Sutter provided inaccurate information about the health status of beneficiaries in their Medicare Advantage plan.
D'Anna v Lee Memorial
Filed
The former auditor is suing due to allegations that Lee Memorial illegally inflated physician salaries in order to get referrals. The hospital denies and will vigorously defend the action, what else can they say.
US v Aurora Health
Settlement
The Wisconsin system agreed to pay $12 million to settle allegations that they filed false claims that stemmed from illegal payments to two physicians over 4 years. This stemmed from a whistleblower complaint but since there was no intervention by the feds nor the state all will move to dismiss the qui tam complaint.
US v Keepers
Indicted
Dr. Jerry Keepers of Kingwood, Oklahoma was indicted for soliciting and receiving over $860,000 in bribes and kickbacks from Dr. Gary Lee and Christopher Parks. This is another of the compounding prescription fraud cases that have blossomed in the past six months. Keepers was allegedly paid to write prescriptions for the unneeded prescriptions and funnel them to a pharmacy owned by the other two.
US v Coordinated Health Holding
Company
Settlement
The Pennsylvania health system agreed to pay along with its CEO Emil Dilorio, MD, $12.5 million to settle allegations they provided false claims for ortho billings. They illegally unbundled to get more revenue.
US v Actelion
Settlement
The drug maker agreed to pay $360 million to settle allegations that they illegally used a foundation to pay the copays of thousands of Medicare patients taking their drugs.
US v Conigliaro
Convicted
A jury convicted five people in connection with the terrible meningitis outbreak caused by th New England Compounding Center. Those convicted were Gregory Conigliaro, Gene Svirskly and Christopher Leary.
US v Ahmed
Sentenced
Dr. Faiz Ahmed of Huston was sentenced to five years in prison for conspiracy to fraudulently bill Medicare. He agreed to approve the unnecessary testing and allow his number to be used illegally. Her was also ordered to refund over $4 million. Top
US v EWTN Global Catholic Network
11th Circuit
The appellate court vacated an earlier verdict against the network after the parties settled a contraception case. Under the settlement EWTN will not be required to provide contraception, sterilization or abortion meds to its employees. This is no precedent as it only disposes of the case after the feds gave in.
Independent Living of S. Cal. v
Kent
9th Circ
The underlying case involved a decrease by California of 10% in Medicaid fees for providers. The plaintiffs won after the defendants removed the state filed case to federal court and then sued for attorney fees. The district court denied the fees saying state law that allowed them should not apply to a federal case. The 9th reversed stating the original claim was under state law not federal law and involved a state Code of Civil Procedure.
Planned Parenthood v Kansas
US Supreme Court
The high court allowed a lower court verdict to stand by not taking the case. The lower courts had rejected Kansas and Louisiana appeals to end funding for Planned Parenthood.
Patients v J&J
Filed
The company has quietly been settling suits against it for the Pinnacle hip originally made by DuPuy. J&J has lost several suits regarding this hip prosthesis in past years but has had luck in getting damages reduced or cases overturned.
Religious Institutions v US
Judicial Decision
Another federal judge has sided with religious institutions against the feds Obamacare birth control mandate. The judge permanently blocked the feds from forcing the plaintiffs to cover sterilization drugs or contraception drugs devices, procedures and related education and counseling in their health care plans.
Texas v US
Verdict
A Texas federal judge has ruled Ocare illegal since the lynchpin of the original Supreme Court Ruling is no longer applicable. When the individual mandate was removed earlier this year this made the taxation aspect of the law no longer valid and the law illegal according to the judge. This will be appealed to the 5th Circuit and the Supremes. Top
Patients v East End Disability
Associates
To Be Filed
About 900 program participants and their guardians had their medical date breached due to an email hacking. After the attack they instituted the safeguards wich should have already been there.
Patients v San Mateo Medical
Center
To Be Filed
The medical center was negligent in the disposal of the medical records of 500 patients when a box of records was recycled instead of shredded due to an employee error.
Indiana v Medical Informatics
Engineering & NoMore Clipboard
Filed
The state AG has filed a federal suit against the companies after a data breach of 3.9 million people. The suit claims MIE violated provisions of HIPAA. Indiana joins multiple other states in this case.
Patients v Chatterjee
To Be Filed
Dr. Chatterjee retired from practice but kept the medical records of her OB/Gyn patients in her garage. She sold the house to the Borgesons and when they moved in they found thousands of records. They asked Dr. Molly Chatterjee to remove them and were allegedly told just to move them aside. They actually reported this to HHS and moved them to a locked storage unit. Dr, Chatterjee then went to the police to file a claim for stealing her property. HHS has said to give the records back to Chatterjee but the Borgesons are afraid she will not keep them safe so they keep them in the locked storage unit.
OCR v Advanced Care Hospitalists
Settlement
The medical group agreed to pay a fine of $500,000 to settle HIPAA violations. The group hired a bogus person to provide medical billing services. The names and other information became viewable on the practice website and may have been visible for several years. An investigation found there was no business associate agreement with the individual as required by law.
New Jersey v EmblemHealth
Settlement
The New York insurer will pay New Jersey $100,000 to settle claims that they breached HIPAA when a vendor sent out information erroneously to over 81,000 people including over 6000 in New Jersey.
Patients v University of Maryland
Medical System
To Be Filed
The FBI is investigating a ransomware attack on the university computers. They do not say how the attack was perpetrated.
Patients v Baylor Scott and White
To Be Filed
The medical center had a vendor compromis 47,000 patients credit card information. The cyberattack was found an hopefully quickly remedied so no information was compromised.
OCR v Pagosa Springs Medical
Center
Settlement
The Colorado hospital agreed to pay $111,4000 to settle allegations that they violated HIPAA. A former employee continued to have remote access to the hospital's web based scheduling calendar after separation of employment. The hospital disclosed PHI of 557 patients to the employee. There was no business associate agreement in place. Top
Highshaw v Altru Health
Filed
Dr. Ralph Highshaw, a urologist in Florida, filed the case in North Dakota. He claims that the hospital discriminated against him for being a Scientologist. He already lost a similar case when the North Dakota Department of Labor and Human Rights found no evidence that the hospital discriminated against him or created a hostile work environment based on religion. This claim was filed in January 2017. Altru stated the problem was his performance not his religion. He was put on admin leave and told to participate in a behavioral health program but he said that would violate his religious beliefs and resigned.
Mon Health v West Virginia
University Medicine
Filed
Mon Health sued Dr. John Lobban last May for breach of contract when he left to practice at WVU. He was accused of misappropriating trade secrets in order to bring 400 of his patients to WVU. Lobban filed a counter claim for breach of contract. The two organizations are trying to work it out.
Beltran v Huntington Hospital
Filed
Martha Beltran went from housekeeper to RN over the 30 years she worked at the hospital. She states when two new supervisors came on scene in October 2017, Latino and Black employees were singled out for reprimands. She was given a reprimand for a date she was not work. She was eventually fired for violations of professional conduct. The hospital is now in trouble because 13 other nurses have also complained that white nurses are getting rid of nurses of color. 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.