February 1, 2009 Recent Legal News
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The following was printed in the December 15, 2008 Recent Legal News. I have recently received the message that follows the original.
I do not change the original stories but I do print most letters without changes.
US
v SouthernCare
Settlement
SouthernCare, An Alabama hospice has agreed to pay $34.7 million for submitting false claims for people who did not qualify for hospice care. This was a whistleblower case. The two whistleblowers will split $4.9 million.
Minnesota
v Austen
Guilty Plea
Kim Joann Austen who worked at the DHS created a false ID and billed Medicaid for over $1 million. She falsified 23 claims but pled guilty to one count of healthcare fraud.
US
v Lopez
Sentenced
Yet another Miami, Florida, DME person is going away for submitting false bills to Medicare. Alfredo F. Lopez owned multiple DME companies in Miami that submitted $16 million in false claims for items never provided.
Florida
v Espinal
Fla Ct App
The Florida Court of Appeal assured that fewer physicians would take Medicaid patients by ruling that Dr. Espinal has to repay to the state overpayments that were the fault of the state. An agency had audited the solo practice and found the solo pediatrician had not abided by all the unintelligible rules set forth by the state so was ineligible to keep the money sent to him. Those in Florida who continue to take Medicaid should not.
US
v Pfizer
Settlement
Pfizer announced in the small print when it acquired Wyeth that it had settled a federal charge that it marketed Bextra for off label use. The company paid $2.3 Billion for the now off the market drug illegal marketing.
US
(Kosenske) v Carlisle HMA
3rd Circ
The 3rd Circ reversed a summary judgment for the hospital that it violated the Stark law with it's arrangement with the anesthesiologists. The dispute was over pain management services and the lack of the hospital making the anesthesiologists pay for the lease of the outpatient space or the personnel supplied by the hospital. The anesthesiologist were not the problem but the pain physicians who were in a position to refer to the hospital were.
US
v Awad
9th Circuit
Dr. Aziz Awad was convicted of Medicare fraud for illegal billing and money laundering. He vastly surpassed other California physicians in billing for respiratory treatments. The Circuit let stand the 180 month prison sentence.
Town
and Country Hospital v Memorial Hermann Hospital
Settlement
Town and Country hospital accused Herrmann Hospital of antitrust in not allowing insurance contracts to be given to Town and Country. In the Houston, Texas, area. T&C Hospital did get a contract with Cigna and Hermann threatened to terminate its contract with Cigna and got a lucrative contract by Cigna. The same thing happened with Aetna. T&C Hospital eventually had to close due to the lack of the contracts. Hermann is enjoined for 5 years from doing any more illegal acts and pay a fine of $700,000 to the state. The hospital actually did well on this since it closed a competitor and got higher contracts for only $700,000. Top
NY
v Nurses
NY Appellate Ct
Wisconsin
v Neumann
Indicted
Mr. and Mrs. Neumann believed in prayer and prayed for help when their 11 year old daughter became ill. As she continued to deteriorate they prayed more but did not bring the girl to a physician. The girl died from juvenile diabetes. The judge stated the parents should stand trial and not be allowed to hide behind religious freedom when it affected not them but their child. The case will turn on whether or not the parents knew the seriousness of the child's condition. The parents face 25 years in prison. Top
Minnesota v
Allina
Filed
The state attorney general has filed suit against the health system for usury. The state caps medical interest rates at 8% but Allina charged 18% for up to $5000 and $12% for debts above this to $10,000. Allina had recently reduced its interest rates to the allowed 8% but the state wants a refund to those who paid more plus a $25,000 fine per incident.
California v
Blue Shield
Injunction
A LA judge has agreed with the LA City Attorney who has filed a class action suit against the insurer for its illegal and immoral rescissions. Blue Cross had tried an end run by sending letters to all those they screwed offering $1000 if they agree not to sue them. They are real snakes.
California ER
Docs v California
Filed
Several ER groups filed a class action law suit against the state for poor pay via MediCal (Medicaid) causing emergency rooms to close and poor care for its citizens.
Patients v
Scripps Medical
Filed
A class action law suit was filed against Scripps and its ED physicians for balance billing patients seen in the ED with HMO insurance that is not accepted by the hospital or its physicians. This is from the recent California Supreme Court verdict not allowing balance billing. There should be many more of these suits by bottom swimming attorneys.
Patients v
Advocate Health
Settlement
The Chicago organization agreed to provide charity to those within 400% of the poverty level. They will go back as far as November 2000 and refund monies. There is no mention in the article how much money will be siphoned off by the attorneys.
Watanabe v
Blue Shield
CA Ct App
Watanabe was a member of Blue Shield HMO via an IPA Good Samaritan Medical Practice Plan. The patient complained of dizziness and went to her physician who sent her to an ENT, reason?. Also she was sent to an optometrist for blurred vision. She had to pay $65 for this visit since she was told it wasn't covered. Eventually the symptoms increased and the PCP finally asked for approval for a brain CT. It was approved while she was on a trip and when she returned she had the test which showed a non-cancerous cyst. This was removed and she did well. She sued Blue Shield for the liability of the IPA which had previously settled for $150,000. The courts said no. Blue Shield is only responsible for its errors and owes the patient $65 for the optometrist visit. Blue Shield is not liable for the med mal of the IPA.
Kingsbrook
Hospital v Allstate
NY Sup Appellate
Kingsbrook Jewish Hospital treated an auto accident patient. They submitted the bill to the auto accident insurer. The insurer refused to pay since they contended that some of the treatment did not relate to the accident. The insurer lost because the deciphering of the hospital codes by the insurer's attorney is not sufficient. The information requires an expert and as everyone knows attorneys are not experts.
Providers v
California
USDC
A coalition of providers and beneficiaries sued the state over a proposed 5% decrease in Medicaid payments. The judge ruled that the state had the burden to prove that the cuts would not injure patients and failed to do so. This is the second time these cuts have failed. The first one was for a 10% cut. Top
Poliner v
Presbyterian Hospital
US Supreme Court
In a case closely watched by all involved in peer review, the United States Supreme Court refused to hear the Poliner case thereby allowing the judgment of the 5th Circuit denying any damages to Poliner to stand. The 5th Circ stated correctly that HCQIA does not allow monetary damages for illegal and immoral peer review.
Smigaj v
Memorial Hospital
Filed
Dr. Diana Smigaj, an OB in Yakima, Washington, has filed suit against her hospital. She is smart by suing for an injunction and not damages except for defamation and violation of the Consumer Protection Act. The hospital is accused of unsafe practices. Dr. Smigij's former associate has stated that the hospital is run by the good old boys who do not want competition. This OB had 300 of his GYN cases reviewed and was suspended for a short time until a peer review committee overturned the biased determination. Dr. Smigij was hired to become the head of the perinatologist unit at the hospital. She was immediately challenged by another OB who backed off after an antitrust attorney wrote threatening the physician. Her baggage has been since her recruitment in 1999. The same physician and competitor has been behind the constant problems. In 2008, she was suspended by an ad hoc committee that was made up of her competitors. The suspension was overturned by the hospital executive committee after the charts were reviewed by out of town specialists. This was a front page story in the Yakima newspaper.
The following was printed in the 1/15/09 Legal News. I received the email that follows this article recently.
Cole v St. James Healthcare
Montana Supreme Ct.
The high court agreed to the injunction filed by Dr. Cole against the hospital to put him back on staff and not taking any further action against Dr. Cole. The hospital had reduced his staff status from active to consulting without notice or hearing. The hospital then illegally hired an attorney to investigate the physician instead of the medical staff doing the investigation as per the bylaws. The physician refused to cooperate with the illegally appointed attorney and filed the suit. The court stated that the hospital did not give the bylaws required three month notice of a reduction in staff status, the physician had an excellent chance of winning the breach of contract suit against the hospital. This hospital needs a new CEO and a new attorney who is able to read bylaws.
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Hi, I'm Cole. Been reading your blog for the link for some time. You should know I did not oppose having an investigation performed through the medical staff bylaws at the injunction hearing...we specifically said that I did not object to following the bylaws. The injunction just told hospital its board of directors could not do it. I had nothing to hide...there is, as you might suspect, much more to this case. Actually, the hospital did fire the old CEO and the old attorney handling this case. It's been quite a ride. I'm still here in Butte, practicing radiology. The hospital has gone in two years from being a moneymaker to losing 1-1.5 million a month. take home lesson for me...we have fewer friends than we think. |
Mercer County
Kansas Supreme Court
Friedman had his medical license suspended after he had already moved to another state and was practicing. He sued for an injunction and lost since he did not fulfill all the administrative hoops required prior to filing suit. The high court agreed that one must jump through the hoops prior to filing suit.
Talwar v Mercer
County
ND Ohio
Talwar applied for privileges at the hospital and was refused since there were omissions in his application. Stupidly, he sued for discrimination instead of fixing the application. The court rightly said he and not the hospital has the duty to complete the application. Of course, he lost.
Rivera v Smith
SD NY
The physician sued the hospital and other physicians for requiring him to undergo a psychiatric exam an have no further contact with a nurse after he harassed a nurse with whom he had had a prior relationship. He did not comply with either requirement and was fired. He sued under the ADA and of course lost. I think the physicians are getting dumber and attorneys love dumb doctors with money. 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.