January 1, 2008 Recent Legal News
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Patients v BCCP
To Be Filed
About 7000 Indiana women had their health information stolen this month. The state agency had computers stolen with the names, addresses, SSNs and birthdays on the computer. Fortunately the information is double password protected, one to log on the computer and one to access the information. The state wants the victimized consumer to get a credit report and place a fraud alert on their records. The state did not offer to pay for anything. Top
US v Community Hosp
Settlement
Community Hospital of Ventura California is back in the news. After its unsuccessful attack on its own medical staff which resulted in the firing of many of its administrators, it is now up for fraud. The Hospital system has agreed to pay to the Medicare program $1.5 million for illegal kickbacks to its physicians by giving interest free loans, jobs for family members and gifts for referrals to the hospital. Sounds like the Board needs to be replaced as well as the administrators.
Texas v Blue Cross
Settlement
Blue Cross has agreed to pay $4.5 million settlement which includes a $500,000 payment to three hospitals for indigent care. The remainder of the money went to eight clinics for care. The original suit was for the take over of Texas Blue Cross by Illinois Blue Cross.
US v St. Joseph
Settlement
Tamy Ramsey, RN blew the whistle on St. Joseph Hospital in Atlanta, Georgia. She found the hospital billing Medicare for patients that should have been outpatients or observations status. She went to the the hospital and physicians about her findings but was ignored. She is now $4.9 million richer and the hospital is $26 million poorer. Dumb hospital with administrators that don't deserve to be there and aren't.
Hailey v Blue Shield
Ca Ct App
Steve Hailey, a small business owner, had his medical insurance cancelled by Blue Shield after a car accident. The company went back at that time and found a mistake on the original application for insurance. The decision states that insurance companies must check the forms when the person applies and not retroactively not pay unless the misstate is willful. This goes with the California Department of Managed Care going after Kaiser, Blue Cross, Blue Shield and others for the same bad conduct. The case will now go back to trial court and requires Blue Shield to pay the appellate costs for Hailey. The issue at trial will be if he intentionally deceived the company. This means that hundreds of cases will go to the jury against insurance companies for the same thing. This may include punitive damages. The patient had permanent damage due to a delay in surgery because of the insurance issue. Top
Trover v Paxton Media
WD KY
Dr. Trover, a radiologist at a hospital, was named in a newspaper story about the hospitals investigation of the physician and his eventual removal from the medical staff. The physician sued the paper claiming defamation. The paper defended in summary judgment by stating the radiologist was a public figure and as such was fair game. The court disagreed. The radiologist never agreed to be a public figure, never sought the story and was not the original focus of the story. The court also said that there was a question of the truthfulness of the source of the story and the accuracy of the report. The court allowed Dr. Trover to sue for false light invasion of privacy but not emotional distress or interference with business opportunity since there was no malice. Top
Allstate v Thorpe
Nevada Supreme Ct.
In an interesting case a physician sued in state court for declaratory relief to see if he had a private right to sue the insurer for not complying with the State's prompt payment law. The original court said that the physician had to go through the administrative process prior to suit. The high court said even after the administrative process including a ruling from the Nevada Insurance Commissioner, the physician had no private right to sue but could only appeal to the courts to overturn the Commissioner.
Tuli v Day
Filed
Three female Indian neurosurgical residents at Boston's Brigham and Woman's Hospital have filed charges of discrimination by the head of neurosurgery to the Massachusetts Commission against Discrimination. The matter is under investigation. Top
AAPS v Texas Med Board
Filed
I believe that all know if the inefficiency of the Texas Medical Board (TMB) with their very slow processing of applications to practice in their state. They have also been accused by several of corruption and have now been sued by the AAPS on behalf of their Texas members for misconduct. They accuse the TMB of manipulation of anonymous complaints, conflicts of interest, violation of due process, breach of privacy and retaliation. They are now under investigation by the state for the same charges. The suit states that the Board president, Roberta Kalafut has manipulated to have have anonymous charge brought to the board by her husband against her competitors. The suit also states that the conflict of of the Executive Chair who served as a plaintiff witness in at least 50 cases before the Board and also lied about it. Top
Sarkisyan v Cigna
Filed
Cigna was charged by an attorney for the 17 year old girl who was initially denied a liver transplant by Cigna wit med mal and he also requested the company be charged with murder. Of course, that was just for show. The patient had leukemia and had a successful bone transplant. She also needed a liver transplant and was placed on the transplant list by the hospital, UCLA. A liver was available in four days but Cigna deemed it experimental and refused to pay. There was a huge amount of anti Cigna publicity and then the insurer decided to allow the transplant. The patient died the same day due to liver failure and was taken off of life support. Cigna's denial was signed by a nurse and Cigna stated that the case was reviewed by two experts who stated that it was experimental and would not help. The experts were never identified and went against the experts taking care of the patient. They will be identified in the discovery process. 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.