July 15, 2016 Recent Legal News
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West Virginia v US
DC Ct App
The DC Court of Appeals ruled 3-0 that West Virginia had no standing to sue the feds for Mr. Obama's infamous lie that those who liked their insurance could keep it. They were not injured even though they were left holding the bag. They could do whatever they wanted, either enforce or not enforce the law requiring people to get the high price insurance.
Central United Life Insurance v
Burwell
DC Ct App
A different panel of the appellate court a rule of the Obama administration that barred the sale of do not meet the stringent standards of Obamacare. The court ruled that the feds (HHS) had over stretched their ability to rule by fiat. Coming from the Democratic packed court that says something. The type of plan at issue would pay the consumer a fixed dollar amount for each visit or hospital day. HHS said this type insurance could only be sold to those who already have a regular Obamacare policy. Since 1996 fixed indemnity insurance has been exempt from federal insurance standards and since Congress did not put it in it continues to be out. For those who do purchase the insurance in lieu of Obamacare they still would need to also pay the Obamacare penalty.
Capitol Health System v Horizon
Healthcare Services
NJ Sup App Ct
The hospitals sued Horizon for its tiered system. They say they did not get sufficient notice on how to qualify for the new tier. Horizon states the contract with the hospitals give Horizon the right to establish a new network without the hospital participation. The hospitals want to view the criteria documents and the trial court agreed. The appellate court overruled saying the documents are irrelevant to the cause of action asserted by the hospitals and contain proprietary information.
Education 4 All v California
Filed
The non-profit and some parents sued the state in Federal court for the vaccine immunization program of the state. They want a preliminary injunction while the case winds its way slowly through the courts. The plaintiffs failed to qualify for the ballot so they are trying another tactic but will lose. The law requires vaccination for school or day care. The only exception are for medical reasons.
Knapp Medical Center v Burwell
DDC
Hospitals do not like competition. Several non profit hospitals got together to challenge a physician owned hospital being able to increase beds. They had applied for and received approval from HHS for their expansion. Both parties filed a motion to dismiss based on lack of subject matter jurisdiction. The court said there can be no review of the administrative or judicial process. The physician hospital won. Top
US v Drayer Physical therapy
Settlement
The South Carolina provider settled with the feds for $7 million. They submitted claims for services rendered to multiple patients being seen at the same time as if they were being treated as individuals. This is a whistleblower case and the blower will get $1,680,000.
US v Cutler
Settlement
Dr. Martin Cutler, an ophthalmologist in Woburn, Massachusetts, has agreed to [ay $55,000 to resolve allegations he submitted false claims. He was accused of billing for imaging when there was no underlying diagnosis to support the claim. The whistleblower will get $11,000.
UnitedHealthcare v American Renal
Associates
Filed
The suit accuses the dialysis folk of falsely billing for dialysis services. They are said to have pushed the Medicaid folk into expensive UnitedHealth plans so the could get $4000 per dialysis versus $200 fro Medicaid. The American Kidney Fund paid the private premiums, a violation of the kickback rules. The dialysis centers also forgave any co-pays. The fund was not sued. UnitedHealth wants its money back.
US v Vista Hospice Care
ND Texas
The whistleblower said that Vista violated the law by admitting and keeping ineligible patients on Medicare. The court said the the evidence did not support the claim. the whistleblower claimed the hospice paid bones for hitting admission targets, an AKS violation. The court said this was protected under the bona fide employee exception. The realtor also did not meet the elements of proof in any case. In the third claim of retaliation the court ruled for the realtor She had finally provided enough evidence that she had good performance reports until she raised her concerns and was fired soon after raising the concerns.
US v MD2U
Settlement
The home care outfit agreed to pay at least $21 million. They admit they violated the False Claims Act as did the directors of the organization. They agreed to pay $3.3 million per year plus a percentage of the corporation net income over a five year period. The organization admitted to billed for unnecessary home visits and exaggerated the level of service.
US v Thompson
Sentenced
Dr. Isaac Kojo Anakah Thompson of Delray Beach had previously pled guilty to healthcare fraud. He was now sentenced to 46 months in the pokey. His crime was diagnosing his patients with ankylosing spondylitis which allowed Humana, a Medicare Advantage Plan to get more money for serious conditions. He got more money per patient in the capitated network.
US v Patel
Settlement
Nita K. Patel and Kirish Patel of Rockaway, agreed to pay the feds $7.75 million for submitting false claims. The Patels forged physician signatures, conducting tests without the physician present as required, creating fraudulent test reports and false billing on the false reports.
US v Evercare (Opium
Palliative and Hospice Care)
Settlement
The Minnesota company agreed to pay $18 million for falsely claiming reimbursements for people not eligible. They were receiving Medicare hsice payments even if not terminally ill. Top
Pacific Radiation Oncology v The
Queens Med Center
Hawaii Supreme Court
The physicians provided service to the patients at the hospital, the only radiation licensed facility in Oahu with an operating room. Queens changed to a closed facility excluding Pacific. Pacific sued for violating due process and Queens countersued saying Pacific stole patients. Queen found 132 patients that went to Pacific but never returned to Queens for radiation. They sought the records of these patients from a competing facility. Pacific then filed a TRO challenging Queens right to review its own medical records plus the records subpoenaed. The Supreme Court ruled the records were not discoverable according to Hawaiian law even if de-identified under HIPAA.
Ashraf v Adventist Health
Fla App Ct
Dr. Sualeh Ashraf was a cardiologist at Florida Hospital Apopka in 2008 when her privileges were revoked and she was reported to NPDB. She attempted to go to other hospitals but was denied after receiving the NPDB report. She sued the hospital for defamation saying the report contained false material. The courts ruled that defamation has a two year statute of limitations starting at the time of publication with one exception, the single publication rule. Therefore the statute begins when the first report is issued to the Data Bank and not when each subsequent report is issued.
US v John Muir Health
ND Ca
A former employee had a history of poor performance and after a discussion with her boss her performance reviews were positive and she was promoted. She attended a conference on Medicare billings and found out that physicians needed to be present to supervise procedures. She told the physicians of her concerns that this was not being done and the physicians became hostile. she was soon terminated and sued. The hospital said it was due to job restructuring, whatever that is. The hospital lost summary judgment as to why the employee was terminated. The problem is she got a good report 10 days prior to termination. Sounds like her attorney is much better than the hospital's. Knowing this hospital and their physicians I believe the employee.
Jackson v Jackson Health System
Filed
Brenda Jackson, a secretary at the organization, was fired and sued. She claims the administrators made false accusations and the hospital said she and another illegally accessed the medical records of Jason Pierre-Paul, a New York Giant.
Furr v Ridgewood Surgery and
Endoscopy Center
D Kansas
The former employee was hired at the surgery center as a clinical administrator. One of her duties was to report allegations of sexual harassment. After she reported an alleged incident she was yelled at and harassed by the complained of physician and a colleague. Her direct supervisor told her he could no longer protect her and she resigned. She filed a claim for sexual harassment and lost since she did not exhaust her administrative remedies. Her claim for constructive discharge also was lost due to her not showing she was treated any differently than a male. Her final claim for retaliatory harassment she won and could continue to court. Top
Yount v Johnson & Johnson
Penn Trial Ct
Yount developed gynecomastia after taking Risperdal, an antipsychotic drug. The jury believed that the company failed to warn the physician of the side effect and it intentionally falsified evidence. The result is a ridiculous $70 million verdict. This is one of many claims against the company for this drug. The problem is really that Risperdal was prescribed off label (legal) but it was promoted for these off label uses including ADD (not legal). This case will be settled or the money reduced to about $2 million where the other cases have been.
Plaintiffs v Johnson and Johnson
ND Texas
The judge allowed a jury verdict against J&J to stand but reduced the damages. The jury had awarded $500 million to three plaintiffs and their spouses for defective hip joint implants. The judge reduced this to $151 million under Texas law. The entire case is being appealed. Ina an earlier case J&J had won.
Tilzer v Sigh
Filed
In a fascinating suit, a pathologist Dr. Lowell Tilzer is suing the head of pathology at the University of Kansas, Dr. Meenakshi Singh and the university for misdiagnosing a patient and then hiding the information from the patient and his family. A biopsy was said to contain cancer but after the organ was removed no cancer was found by several pathologists. It is alleged that the chair added an addendum to the report saying the original cancer diagnosis matched the removed organ. Tilzer then went to the university to investigate but they did not. Tilzer then reported it to the Joint Commission and he was accused of lying by the hospital president. The Joint said it does not assess care of individuals.
Miller v Warren Hospital IPA
D NJ
The plaintiff is a baby with birth malformations. He accuses the hospital of vicarious liability in the care and treatment of his mother during delivery. A vaginal swab pre delivery showed Group B Strep and she had a vaginal birth which caused the patient to have the disease. He says from this he got hydrocephalus and other mental and physical problems. He says this is all due to delivering his mother vaginally without antibiotics or not doing a C-Section. The court ruled against the hospital on the summary judgment claim.
Krieg v UPMC
To Be Filed
The plaintiff was a transplant patient at the hospital who contracted a mold infection. Several others also got it and also died. The hospital needs to just write checks.
McMath v Children's Hospital
CA App Court
The family of Jahi McMath who died after a T&A will get a chance to prove she is still alive. The family has filed a suit against the hospital and they can receive much more if Jahi is still alive than if she is dead. She will be examined by the hospital personnel as well as her own. Top
Texas v Cason
Arrested
Tony Cason, a patient at Timberlawn Mental Health in Dallas, was told he would be transferred. He then attacked and killed Dr. Ruth MarDock at the institution. It should be noted that in March the Texas Department of State Health Services moved to close the institution over patient care issues. He is accused of manslaughter.
Pennsylvania v Hamilton Law Group
Settlement
The Attorney General went after the lawyers for their high handed collection tactics on attempting to collect payments from people who had no legal right to pay. This got them this bad publicity as well as a payment of $366 in restitution, a $3000 fine $3000 in investigative costs and $65 in court fees. They also agreed to stop all collection efforts that were based solely on the Filial Responsibility Law.
Idaho v Harvel
Sentenced
Norilina Salvatierra Harvel, the former CFO of Bonner General Health in Sandpoint , Idaho had a withheld judgment for embezzlement. She was sentenced to 90 days of local incarceration and the repayment of money. If she does all her conviction will be removed.
Kaiser v Quinn
Arrested
Kaiser Health Plan has accused Michael Albert Quinn, a former police officer and now insurance claim investigator, of submitting invoices for work never authorized nor legal. Previously he was convicted of embezzling from Nordstrom and also for falsifying evidence. Top
Patients v Veterans Affairs
Medical Center Washington DC
To Be Filed
Somehow the VA lost a controlled substance monthly report with over 1000 names. They have reported this.
Patients v Midland Memorial
Hospital
To Be Filed
The Texas hospital says that a former physician left patient information unsecured in a private residence. Top
Sovereign Health v Health Net
Filed
The company that treats addicts sued the insurer for not paying $55 million for medical services. This is common for Health Net and the company is being investigated by California for the same thing. Top
Pirouzian v Superior Ct
Ca Ct App
Dr. Amir Pirouzian was depressed and took medical leave from his work. He received disability payments. He lied to his disability insurer after he took another joob. He plead guilty to a misdemeanor which was later expunged after restitution and probation. Years later the MBC voted to revoke his license. Teh Court of Appeals overruled the Board saying revocation of his license was too harsh a penalty for what he did . The ALJ did this because they were mad the penalty imposed was too lenient. This does not reflect well on the ALJ nor the MBC.
Gerner v Superior Court
Ca Ct App
The MBC lost another case when they attempted to obtain the records of Dr. Garner's psychiatric patients. He fought in court and the court of appeals ruled that the psychiatrist-patient privilege is greater than the physician -patient privilege. They went on to say that no exception to the privilege could be judicially created. This case is legitimate on both sides.
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.