July 1, 2011 Recent Legal News





Employment Peer Review







In re Miguel M v Charles Barron
NY Ct App

The court ruled that HIPAA prohibited the disclosure of a patient's medical record to a State agency that requests them for use in a proceeding to compel the patient to accept mental health treatment, where the patient has neither authorized the disclosure nor received notice of the agency's request for the records.  No court order had been sought or obtained.  The two  hospitals just gave the medical records to the New York City Department of Health.  The lower court allowed this to occur but the higher court reversed.  The state law does not provide more protection for the person's medical records than HIPAA and no exceptions are available in this case.  

Patients v NHS

In London the NHS lost a laptop with 8.63 million people's medical information on it.  They then did not report it missing for three weeks.  This was only one on 20 laptops missing from a storage room in the NHS.  Eight have been recovered but not the one with all the information.

US v Kaye

Richard Kaye of Suffolk, Virginia, was indicted for wrongful disclosure of PMI .  Dr. Kaye is a DO and Medical Director of the Psychiatric Care Center at Sentra Obsci Hospital in the city.  He on three occasions disclosed information to a patient's employer without the patient's consent.  If convicted he faces up to five years in prison.   

Patients v California Dept. of Public Health
To Be Filed

The Agency announced a breach that took the information on 9000 people.  The information included SSNs.  This is the second breach in less than a year at this agency.  Information on a magnetic tape was sent by USPS instead of private courier and never arrived.  The employee who did this was placed on leave.        

US v Wilson

Phyllis Wilson of Baltimore pled gui9lty of stealing the personal records of residents and employees at assisted living facilities where she worked.  She used the information to open fraudulent accounts.  She faces 30 years in prison.        Top


Thomas Moore v US
6th Circ

The 6th Circuit has ruled that Obamacare's mandate to require insurance is legal.  This will be appealed to the US Supreme Court.

Delany v New Hampshire
Supreme Ct of New Hampshire

Delany is the Attorney General of the state.  The legislature passed a bill ordering him to join other states in the fight against Obamacare.  Delany did not think the legislature had this ability and sued.  The Supreme Court agreed with the Attorney General.  He stated and made the point that his office is independent and not under the rule of the legislature.  The Supreme Count decision was unanimous. 

US v Stewart

Catherine Stewart was arrested for stealing hospital information regarding 4500 patients from Trinity Medical Center in Birmingham, Alabama.          Top 


California v Vasin

Yevgenly Vasin has been charged with impersonating a physician in Redwood City, California.  He was turned in by the family of a patient who died.  The patient had MS and was instructed by Vasin to only take half doses of the UCSF prescribed meds and go on vitamins.  He also had a woman sit in a tub of warm water to treat her kidney problems.  Vasin charged $300 per hour to treat the MS patient.        Top


US v Killmer

Edward Killmer, Jr., the owner of Bay Area Sleep Associates dba SommoMedics, LLC in Florida was charged with cheating the feds by billing for sleep studies done by unlicensed technicians.  The techs need to licensed for payment by Medicare.  This was a whistleblower case by a licensed sleep tech.

US v Hardimon
SD Ill

Chiropractor John Hardimon in Shiloh, Illinois was sentenced to 70 months in jail for fraud and ordered to repay multiple insurers $1,937,392.68.  The government confiscated $714,641.13 as well as a BMW, two Minivans and two residences.

US v Midtown Imaging
SD Fla

Midtown Imaging agreed to pay the government $3 million to resolve allegations of false billings.  This was a whistleblower case by two radiologists for entering into illegal arrangements with referring physicians.   

US v Buono

 Anthony Buono of Wallingford, Connecticut, was sentenced to 18 months of prison and three years of supervised probation for Oxycontin illegal purchase and distribution.  

US v Vah Lavien

Joseph Vah Lavien of Brooklyn Park, Minnesota, has been charged with defrauding Medicaid in the home health business.  He is being charged on one count of billing for services not rendered.  

US v Nine

 Nine people have been accused by the south Florida US attorney for giving and receiving kickbacks for hospital goods contracts.  The hospital is Memorial Hospital West in Pembroke, Florida.

California v Physicians

Orange County prosecutors have filed charges against Drs. Sim Hoffman of Newport Beach and Thomas Heric of Malibu along with others of billing for procedures never done. 

US v Odachyan

Petra Odachyan of North Hollywood, California, pled guilty to fraud for unnecessary DME.  He was sentenced to 51 months in a fed prison.

US v Ball

Simone Ball of Houston pled guilty of fraud of billing Medicare for unnecessary or not provided DME. 

US v Houston

Kemmie Houston and Sharon Beal both of Houston pled guilty of conspiracy to commit Medicare fraud.  They submitted claims for their DME company STK Consultants for things that were not necessary or not given to patients.  They each face 10 years in prison.

US v Haber

Maria Haber of Detroit was sentenced to 15 months in prison and pay $1,004,343 in restitution for a fraudulent diagnostic testing scheme at CompleteHealth and Ritecare.   She was only one of 10 defendants in the case.   

US v Shteyman

Three employees of a Brooklyn physical therapy clinic pled guilty of fraud for paying kickbacks to Medicare beneficiaries to come to the clinic.  Solstice Wellness Center employees Dmitry Shteyman, Alesksey Shteyman and Maxsim Shvedkin all pled guilty to conspiracy to commit healthcare fraud.   

US v De Los Rios

Dr. Rene De Los Rios of Miami has been sentenced to 19 years in prison for signing medical documents authorizing tests and treatments that were not needed or never performed.  Dr. De Los Rios is 72 years old and was also ordered along with a co-defendants to pay $11.7 million in restitution.  

US v Gabriel

Jacinto Gabriel, Jr. has been indicted for scamming $20 million from Medicare.  This again was for DME not necessary nor provided.  He is the owner of Perpetual Home Health, Inc in Oak Forest, Illinois and Legacy Home Health in Chicago.       Top

Employment Peer Review

Bribiesca v Scripps
Ca Ct App

The perfusionist was part of a corporation which had a contract with a hospital.  The corporation enticed the hospital to drop the corporation and hire all but the one perfusionist back.  The corporation then warned the hospital that the perfusionist may become volatile when he learns about this.  The hospital permanently banned the perfusionist from the hospital.  The perfusionist sued for emotional distress for the banning.  The hospital attempted to institute an anti- SLAPP procedure which was granted by the lower court.  The court of appeals reversed and allowed the suit to go forward since the perfusionist has a good chance of winning the suit.   

Chudacoff v University Med Ctr of S. Nev.
9th Circ

Dr. Richard Chudacoff, an OB at the hospital, was granted privileges.  shortly after he received notice that his privileges were suspended by the MEC.  There had been no known investigation of him prior to the suspension. The hospital then filed a NPDB report before the peer review hearing.   He filed for a peer review hearing and won there.  While the peer review was going on he sued the physicians and the hospital for violations of his due process under the Fourteenth Amendment.  In the District court he won partial summary judgment and the defendants were found to be not covered due to lack of any pre suspension hearing.  There can be no private right under the 14th Amendment so the plaintiff amended his claim to a Section 1983 violation.  The defendants were then released since the District Court did not consider them state actors as they were independent contractors.  The plaintiff appealed and the 9th Circuit ruled that since they were acting for the district hospital they were state actors and were able to be sued. The hospital was deemed not a bona fide defendant and the state claims were dismissed.  This leaves the physicians of the MEC hanging in the breeze.  It boggles the mind how the physicians could do what they did and think that they would prevail. I hope they lose lots of money individually.  This would send a message to other MECs to follow due process.  

Lewis-Gale Med Ctr v Alldredge
Va Supreme Ct

The physician was part of a group and the hospital told the group to take care of the problem physician.  The group fired the physician and the physician sued the hospital for interfering with the contract between the group and the physician.  The jury awarded the physician $900,000 and the Supreme Court overturned the verdict stating that the contract between the group and the hospital as well as the contract between the group and the physician were both at will.    Top


Tufts v Lifespan Hospitals
NH Dist. Ct.

Tufts sued Lifespan for making Tufts (then New England Medical Center) a subsidiary of Lifespan take unfounded financial risks without disclosing all the information.  Tufts wanted $135 million but received $14.2 million.  They will not get that since Tufts owed Lifespan $13.9 million as part of its disaffiliation from Lifespan. 

Narayan v Mt. Clemons Med Ctr
Mich Ct App

The physician was suspended for 14 days and denied a hearing.  The physician sued the hospital and the hospital stipulated that the physician could return to the hospital with consultation privileges only.  The court read the letter sent to the physician which gave him back full privileges not just consultation.  The court then stated the counsel for the hospital stipulated to a false fact and made the hospital pay the physician attorney fees since he was fully restated.  The attorney appealed the decision and lost. The original trial ended in a mistrial and a second trial found for the physician on the tortious interference claim and awarded $20,000.          Top


California v Anthem Blue Cross

Anthem agreed to limit rate increases for 122,000 policyholders whose plans have been closed.  They could also switch plans without having any review of their medical histories.  This was against state law.  Anthem made a big deal about saying the settlement admits no wrongdoing but all know the truth.        Top


Pilva V Messing
US Supreme Court

The court in a usual 5-4 decision gave generic drug makers a pass on liability for failing to warn people of dangerous side effects as long as their labels follow the brand name counterpart.  This overrules state law that requires labels be updated as drug manufacturers become aware of new risks.  All justices agreed it made little sense but they must follow US law and relevant US regs.

Sorrell v IMS Health
US Supreme Court

In a 6-3 decision the high court ruled that Vermont's law against data mining of prescriptions was unconstitutional.  This means that pharmacies may sell prescription information for drug marketing purposes.  The law violated the first amendment by targeting certain information and speakers who visit doctor's offices and engage in marketing on behalf of drug companies.         Top


Zangara v Advocate Christ Med Ctr
Ill. App Ct

Patients in the hospital sued the hospital after getting MRSA.  They requested the MRSA stats but were refused under the guise of peer review.  The lower court agreed with the hospital but the appellate court reversed.  The court stated that since the information was not generated for a peer review purpose it was not protected and available to the plaintiffs.

Patients v Willis-Knighton Hospital
Louisiana Ct. App.

Multiple patients have sued neurosurgeon Patwardhan for med mal and are suing the hospital in a class action for negligence in allowing Dr. Patwardhan to practice at the hospital.  It is implied the hospital neglected to check the credentials of the physician prior to granting privilege.  The judge ruled the lawsuit can go ahead but has not ruled on the class aspect of the suit.  The physician is not part of this suit and has agreed to stop doing neurosurgery pending a medical board investigation but retains his medical license at this time.      Top


Estate of CalletBois v Hosp Espanol

The court denied a hospital's plea for summary judgment in a case involving a person who was hospitalized for a myocardial infarction and three days post discharge came back to the ED with chest pain.  He did not receive a chest pain protocol and died the following day while in the hospital.  The family sued under EMTALA and medical malpractice.  The court stated that there was enough evidence to suggest the EMTALA violation was causative of the injury.          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.