California v Visher
William Visher, a 70 year old former Capitols psychologist, was sentenced to 16 years in prison for molesting children in his child psychology practice.
US v Stabler
The former CEO of Pine Ridge Indian Health Service was indicted on charges she made false statements to HHS. Wehnona Stabler said she hadn't accepted a gift more the $350 from any source but in fact she accepted $5000 from a former pediatrician at the hospital. Dr. Stanley Weber was arrested earlier this year on charges of sexual abuse. Top
US v Reliant Care Group
Reliant, a skilled nursing acility, agreed to pay the feds $8.3 million to settle allegations that they did unnecessary occupational, speech and physical therapy on patients and then billed those services to the feds. They also got a five year Corporate Integrity Agreement.
US v Kolodesh
Matthew Kolodesh, Alex Pugman. Svetiana Ganetsky and Malvina Yakobashvii, have been convicted on fraud for their part in the Pennsylvania Home Care Hospice scam and now agreed to pay close to $10 million. This is a qui tam suit by two former employees.
US v Compassionate Care of Gwynedd
In a second hospice case the company agreed to pay $2.4 million to settle allegations for admitting patients for "debility" an non cover diagnosis. They also were accused of paying kickbacks to physicians.
US v Carolinas Healthcare System
This North Carolina hospital system agreed to pay $6.5 million to settle allegations they gamed the system by upcoding urine drug tests which were moderate complexity as high complexity to get more money. The qui tam plaintiffs will get $1,365,000.
US v Tarabein
Dr. Rassan Tarabein of Fairhope, Alabama, was arrested on fraud and theft charges. He operated the Eastern Shore Neurology and Pain Center in Daphne, Alabama. He is also accused of money laundering and illegal distribution of controlled substances.
US v Johnson
Dr. John Johnson of Hollidaysburg, Pennsylvania, having been found guilty of accepting kickbacks from Universal Oral Fluids Lab was sentenced to 7 years in prison and to pay to the IRS $722,476 and to pay HHS $2,300,000.
US v Moshin
A podiatrist got a kickback from Sacred Heart Hospital in Chicago. He had a teaching contract for the podiatric residency program. He was to get $2000 per month and then $4000 per month for residency duties that were normally done for free. He spent less time that others teaching and more time operating on more cases than others. The court found this was a kickback for doing the surgeries at the hospital and he appealed. The 7th Circuit agreed with the trial saying the podiatrist knew he was being paid for surgeries and not teaching. Guilty stands.
US v Wal-Mart
The company has agreed to pay $1.65 million to settle allegations that it knowingly submitted claims to California Medicaid that were not supported by diagnosis and documentation requirements. This involved Medicaid's Code 1 drugs that require a special code.
US v CVS
The company has agreed to pay $5 million to resolve allegations that it failed to keep accurate prescription records in California. This had to do with opiod drug losses at certain stores.
US v Mallinckrodt
This company agreed to pay $35 million to resolve allegations that it failed to report suspicious drug orders. They did not notify the DEA of suspicious orders for Oxy.
US v Newton
Contractor Rocky Williams allegedly paid Lexington, Kentucky's, St. Joseph Hospital executive director of facilities James Newton kickbacks to get general contracting work at the hospital.
US v Fernandez
Dr. Roberto Fernandez of Miami pled guilty to fraud for referring patients to pharmacies for kickbacks. The physician wrote more prescriptions than the patient needed so the pharmacist would get more money. He also solicited patients for his practice from the pharmacies.
US v A Huge Number of People
The feds announced the nationwide arrest of 412 individuals including 115 doctors, nurses and other licensed professionals for their roles in false billings along with over prescribing opiods. They charged the feds for narcotics never purchased nor received by the patients. They say this is a boondoggle costing $1.3 Billion.
US v Morrison
Deborah Morrison of Bethesda, Maryland, a former exec at Providence Hospital, plead guilty to stealing $391,600 from the medical staff bank accounts.
US v Diamond
Dr. Howard Diamond of Sherman, Texas, was arrested on charges of fraud and illegal distribution of narcotics. He is linked to the overdose deaths of seven people. Top
Charles Des Roches v California
The parents of two children filed a class action law suit against Blue Shield for improperly denying mental health payments. The suit says the insurer wrongly restricted patient's access to outpatient and residential mental health treatments. The judge has allowed a class action status. The suit goes on to allege the requirement of having to have three months of treatment prior to residential care was illegal. The suit wants the insurer policies to be consistent with the law and generally accepted guidelines and to reprocess thousands of mental health and substance-use benefit denials. This is part of nationwide strategy to force the insurers to pay for care.
Castaneda v California
The suit was filed against the state for not paying enough money to the providers of Medical. This creates access problems for the minorities, especially the Latinos, according to the suit. They say whites get real insurance and they don't. The named plaintiff had to go to Mexico to get her gall bladder removed due to the long waits. She states her Mexican physician said she would have died without the surgery. Top
Patients v UC Davis
About 15,000 patients had their information breached after an employee fell for a phishing scam. Patients have been notified.
Oregon v Vaca
Dawnielle Vaca, a certified nurse assistant at St. Charles Health System, was arrested on charges of illegally viewing the medical records of about 2500 patients at the hospital. This was done for curiosity and not financial gain.
Patients v U. of Iowa
The University of Iowa Hospitals accidentally posted the names and medical records of 5300 patients. The information was not encrypted. There should be a substantial fine by the feds for their lapse.
Patients v DXC Technology
This company is contracted to the Colorado Medicaid department to run its payments. They have been doing a very poor job of paying causing physicians and therapists to take out loans. This may be a reason to finally relieve them of their contract. A "system glitch" has shared the information of over 800 people.
HCA v Sarasota County
HCA and CHA appealed a Florida appellate court ruling that the county did not have to reimburse the private hospitals in the county for indigent care. The high court ruled the legislature made the law and even though it only applies to one county it is valid. The case now returns to be reheard in trial court. This could be a windfall of about $300 million to the county private hospitals. Top
Mayo v Jaffe
Mrs. Mayo sued Dr. Jaffe after she lost her limbs after getting a Strept A infection. The award by the jury of $25 million was reduced to $8.8 million and appealed. the state hifh court said the state legislated caps on non-economic damages is unconstitutional on its face. The cap is $750,000 at present after the state supreme court ruled in 2005 that a cap of $350,000 was unconstitutional but not the law was unconstitutional. The jury found the care satisfactory but the physician did not give alternatives to consider. She had gone to the ED for abdominal pain with a high fever and told to follow-up with her gyne for fibroids. She was told of the possibility of sepsis and not offered antibiotics. This may be appealed to the US Supreme Court.
Dawson v Calhoun Liberty Hospital
The court dismissed all but a possible EMTALA claim against the hospital in the case of the plaintiff going to the hospital ED for abdominal paid and after being examined and released she refused to leave. She was handcuffed by police and placed in a squad car. A ED physician then re-examined her and she died from a pulmonary embolism. All charges against the police and the city were dismissed. Prior to the trial the state fined the hospital $45,000 for deficiencies in the treatment of Dawson and another. This information was not allowed in evidence as it would be prejudicial.
Kumari v The Hospital Committee
for the Livermore-Pleasant Areas
No good turn goes unpunished. The plaintiff broke her shoulder while a patient at the hospital. Four months later she sent an informal letter to ValleyCare hospital requesting $240,000 or she would go to court. One day under the one year statute of limitations a lawyer sent the hospital a required notice of intent to sue. Three months later a suit was instituted. She lost. Why? The informal letter was filed early in the process and the attorney's letter did not stay the statute of limitations. Top
People v Superior Court (Sahlobei)
A surgeon was chief of staff of a public hospital and negotiated a contract with an anesthesiologist for $36,000 per month. The problems was he also pressured the hospital to pay $48,000 per month and pocketed the difference. The trial court found the state law regarding this only applied to employees and not independent contractors such as the surgeon. The Court of Appeals agreed but the Supreme Court overturned and said that certain independent contractors are indeed covered when they have duties to engage in or advise on contracting in the government's behalf.
Ryden v Duluth Clinic
Dr. John Ryden is suing the Clinic for discrimination saying he was fired due to issues secondary to depression and adult attention deficit disorder. This may not fly if there were other issues as well. The main problem seems to have been his charting was far far behind. He also filed a grievance with the Minnesota Dept. of Human Rights that went nowhere. On appeal they did determine there was probable cause on claims of discrimination, failure to accommodate and reprisal. 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.