January 15, Recent Legal News







Peer Review and Employment


US v Bravo

Broward Health can not stay out of the news for long.  Brian Bravo was their corporate procurement officer.  He is accused of hatching a bribery scheme by steering over $22 million in contracts to certain vendors in return for $600,000, vacations and other items including World Cup tickets.        Top


US v Scott

Ivan Scott, the owner of an Orlando telemarketing call center, was convicted of fraud.  He targeted Medicare folk and falsely stated that they should get paid for genetic tests.  He then paid bribes to physicians to get orders for those tests.  The physicians OKed the tests without speaking to the patient or knowing anything about them.  He will be sentenced later.

US v Exceltox

The California lab contracted with a New Jersey man to get seniors to submit to genetic testing.  The tests were not done under a physician's order and therefore were billed illegally.  They paid $357,584 for their screw-up.

US v Apria

The DME company paid $40.5 million to settle allegations that they billed for NIV respiratory equipment they did not monitor or know if the person was still using.  Even when they knew the person had no long used the equipment they continued to bill.

US v Harris
Ca Ct App

Shelia Harris submitted false claims for a speech pathologist who provided no services.  The pathologist was not aware of the billings.  Harris was convicted of identity theft.  She appealed and lost.

Esformes v US

Philip Esformes, the convicted money launderer and briber, somehow got President Trump to commute his 20 year sentence.  He then had the audacity to attempt to get dismissal of the $43 million in penalties assessed.  Let us hope he loses.

US v Devous

Dr. Arnold Devous, an Indian Health Service physician from Billings, was sentenced to three months in prison, two years of supervised release and fined $10,00.  His crime was to prescribe a medication that was not on the formulary at the Blackfeet Indian Reservation for kickbacks from an outside pharmacy.

US v Bencosme

Dr. Yvelice Bencosme or Miami pleaded guilty to fraud.  She fabricated data submitted to an unnamed pharmacy company about an asthma med for children.  

US v Texas Heart Hospital of the Southwest

The hospital in Plano, Texas and its owned subsidiary THHBP Management Company agreed to pay n$48 million to settle allegations that they submitted claims that were no allowed due to kickbacks.  This qui tam suit was filed originally by two physicians who together will get over #13 million.  The hospital required physician owners to satisfy the hospital's yearly 48 patient contact requirement to maintain ownership in the hospital.

US v Addiction Care Interventions Chemical Dependency Treatment Centers

The New York City company agreed to pay $3 million and its owner Steven Yohay agreed to be banned from Medicare and must divest his ownership in the company.  Yohay agreed to pay an additional $3 million.  The company allegedly offered homeless people food and money to purchase drugs so they enroll in the programs.  The allegedly used photocopied physician signatures to fake need.

US v Anderson, Shea, Spencer

Drs. James Anderson, Charles Spencer and Mitchell Shea of the Nashville area agreed to pay a total of $1.72 million to settle allegations that they billed for a peri-auriclar stimulation device known as "P-Stim" which is not a covered service.  Anderson is to pay $1 million over fie years; Spencer $700,000 over five years and Shea $20,000 over five years.

US v de-Graft

Dr. Moses de-Graft lived up to his name.  The Tallahassee physician pleaded guilty of fraud by treating patients with unnecessary heart angiograms when they were not needed or saying he had done the procedures when he had not.

US v Khaim, Khaimov

Peter Khaim and Arkadiy Khaimov, both of Forrest Hills, New York were indicted for fraud.  They owned over a dozen pharmacies and are alleged to have billed for expensive caner drugs that were never provided.  

US v Bartell Drug

The pharmacy filled orders from physicians who wrote for opiates even though they did not have a valid license to do so.  This will cost them $800,000.        Top


California Life Sciences Ass'n v CMS

The district court blocked via a preliminary injunction the feds from implementing a rule that would align Medicare drug reimbursement with international prices.  Previously a Maryland federal court did the same.          Top


King 5 v Seattle Children's Hospital

 After multiple malpractice suits against the hospital for their aspergillos infections the news journalist filed a records release request for the infections to King County Public Health.  The agency said 4700 pages regarding email exchanges and mold sample testing results were fit to release without redactions.  Seattle Children's objeted due to HIPAA and no agreement was forthcoming regarding the what redactions were necessary.  The Washington Dept. of Health said they would release over 800 pages of medical records subject to redaction for PMI.  Children's said that 117 pages of those should be exempt from disclosure and filed a preliminary injunction.  A judge ruled in favor of the hospital and then a Washington appeals judge 720 pages related to mold infections and an additional 117 pages from the Dept. of Health could be released.  A three judge appellate panel agreed and ordered the underlying court to make sure the records comply with HIPAA and then release them.

Patients v Northwestern Memorial Hospital
To Be filed

The hospital has said a temp worker viewed the records of over 650 patients and asked the patients to view the records for accuracy.  The temp worker no longer works there.

Patients v Prestera Center for Mental Health Services
To Be Filed

The West Virginia center did a screw-up with mailing and is notifying 3500 patients that their PMI was exposed.

OCR v Elite Primary Care

Dr. Peter Wrobel agreed to pay $36,000 to settle allegations that Elite failed to provide medical records to a patient when requested.  

Patients v Leon Medical Center
To Be Filed

The hospital was hit with a malware attack.  The hackers got PMI from an unknown amount of patients.  

Patients v Jefferson Healthcare
To Be Filed

The Port Townsend, Washington, facility had a phishing attack which may have gotten thousands of patients information.

US v Banner Health

Banner settled with the OCR and is paying $200,000 for violations of HIPAA.  Two patients were denied access to getting reasonable access to their medical records.  Bad organization.        Top


Coast Hematology Associates Medical group v Long Beach Memorial Hospital
Ca CT App

The medical group got its pants in a tizzy when the hospital lured two of its physicians away.  They sued the hospital for misappropriation of trade secrets and the hospital won a summary judgment claim.  On appeal the court said that the medical group could assert its claim over the RVU assessment but not its CPT codes.  

Hospitals v HHS

Forty six hospitals sued the HHS for reversing hospital debt policy.  The HHS had taken away the ability of the hospitals to get claims for bad debt that were pending at outside agencies.  This has already been decided in the HHS favor by a Medicare appeals panel.  The hospitals are trying again.        Top


Patients v Derby Hospital
Class Action

A class action was granted in a suit against the Waterbury, Connecticut hospital.  They were transparent in disclosing that for six years they had used multiuse injector pens for diabetics on multiple patients.  Not the needles but the injectors themselves.  They got rewarded by the law suit.

Filosa v Alagappan
Ca App Ct

Filosa had symptoms of headaches and underwent an MRI in 2010.  It was read and misinterpreted by radiologist Dr. Algappan.  In 2014 the Filosa had worse headaches along with other physical and mental problems.  A new MRI showed a brain abnormality possibly a tumor.  a review o f the 2010 MRI showed the mass present.  Filosa sued and the trial court agreed with the motion for summary judgment based on the statute of limitations.  The appellate court reversed stating that the rule is the earlier date of three years or one year after a patient reasonably should have discovered the injury.  This fell in the latter.  Case continues.        Top

Peer Review and Employment

Kaki, Elder v Detroit Medical Center, Tenet

Drs.  Amir Kaki and Mahir Elder filed arbitration against Detroit Medical Center and its master Tenet for removing them from the medical staff after they raised concerns about problems in the hospital.  The arbiter found the facility acted with malice (imagine that)  when the fired them.  They won $10.6 million plus reinstatement on the staff.  The hospital is attempting to vacate the award in federal court.  The hospital was also sanctioned $110,000 for discovery abuses and they also have to pay attorney's fees of $624,000.        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.