Fraud
Indiana v Hedrick
Guilty
Dr. William Hedrick was found guilty by a jury of prescribing
pain medicine from his pain clinic and forgery. He was accused of being
responsible for the deaths of eight people.
US v Holmes
Indicted
Elizabeth Holmes and her boy friend and second in command
Ramesh Balwani were indicted for wire fraud. She is the infamous founder
of Theranos, the company that said they could do multiple blood samples from a
very small blood sample. They were called out at first by the WSJ and
later by all. They actually did some tests with a routine analyzer and not
their own proprietary machine. They duped many supposedly savvy investors
out of millions of dollars. She has resigned as CEO of the company.
US v Payne
Indicted
Dr. David Payne, Jeffery Gross and Lokesh Tantuwaya were all
indicted for their roles in a scheme by Pacific Hospital in Long Beach,
California, and owned by Michael Drobot. They are alleged to have received
payments for referring patients to the hospital which is illegal under federal
law.
US v Livingston Regional Hospital
Settlement
The Tennessee hospital has agreed to
pay $744,000 to settle allegations that the submitted false claims for psych
patients care that was not necessary. The whistleblower will get $156,000.
Texas v Xerox
Texas Supreme Court
The court said that Xerox was the
culprit for allowing unqualified people to judge who needed and who did not need
orthodontic surgery. The state sued both the providers and the
company. Xerox said it was the providers that created false information to
get profits.
US v Robinett
Guilty
Dr. Kelly Robinett of Texas was found
guilty oof fraud for signing medical paperwork for home health unneeded.
He never saw any patients he certified for the home health because he got paid
to "rubber stamp".
NY v Anyanwu-Mueller
Sentenced
Collins Anyanwu-Mueller RN was
sentenced to one year in jail. He has repaid New York state $25,000 and
has agreed to pay the remaining $367,954 still owed. The private duty
nurse presented false claims for nursing that was never provided to severely
disabled people.
US v 601 People
Indicted
The US Justice Department has filed
against 601 people for healthcare fraud and opioid crimes. This includes
many physicians, nurses and pharmacists.
US v 16
Filed
As part of the above sweep in SoCal 16
people were indicted. One of the indicted was an attorney Irena Shut who
was accused of paying kickbacks to two podiatrists. She was a marketer for
TTY Consulting to get prescriptions to the pharmacies affiliated with TTY.
She received about $6,8 million for this work. The podiatrists are Domenic
Signorelli and Robert Joseph. in a compounding pharmacy scam six were
indicted. They are Thu Van Le, Cau Nguyen, Truong Le, Kevin Le, Nha Le
Tuan Truong and Jeffery Lawrence. In another pharmacy scam wher
prescriptions were billed for but never dispensed the following were indicted:
Irina Sadovsky, Yigal Keren, Mikhail Khanukhov, Shahriar Kalantari, Andrei
Sotikov, Nida Rosales and Juan Eniquez of Five Star and Ultimate
Pharmacies. Others indicted were pharacist Armen Pogossian, Tamar Tatarian,
Rubin Filian, PA, Dr. Stephen Levine, managers of medical clinics Sarkis
Manukyan and Eduard Tersipyan and Lucille Lam. As part of the same general
sweep the following were indicted for illegal kickbacks at Pacific Hospital in
Long Beach Dr. Daniel Capen, Dr. Timothy Hunt, Dr. Tiffany Rogers, Chiropractors
Lauren Papa and Brian Carrico, Suits George hammer and William Parker.
US v Caris Healthcare
Settlement
The hospice chain agreed to pay $8.5
million to settle allegations that they billed Medicare for patients they knew
were not eligible for the benefits. The whistleblower nurse will get $1.4
million.
US v Paulus
6th Circuit
A jury convicted Dr. Richard Paulus, a
cardiologist at King's Daughter Medical Center, of fraud for billing for heart
procedures that were not medially necessary. The court then overruled the
jury stating the interpretation of angiograms involved subjective opinion.
The 6th reversed and reinstated the jury verdict stating that stenosis is a fact
capable of proof or disproof. The court said that the jury has the ability
to believe one expert or the other.
NY v Corines
Indicted
Dr. Peter Corines was indicted for
stealing money from a 98-year old woman by claiming to be her power of attorney
and impersonating her. He has plead not guilty.
Healthcare
California v Superior Court
Ca Ct App
California has appealed and won a
temporary stay from the appellate court on the End of Life Option Act. It
was correctly called unconstitutional by the lower court judge not because of
the law itself but how the legislature passed it. They used a special
session dedicated to healthcare and this was not healthcare. The law
opponents have until July 2 to file arguments against the decision.
Dordt College v HHS
USDC
Dordt college in Iowa and Cornerstone
University in Michigan sued the feds for a permanent injunction to not have to
provide medical insurance for abortion which goes against their Christian
beliefs. The judge ruled in the colleges favor.
California Dialysis Council v
California
California Supreme Court
The SEIU filed a petition for a
proposition to be put on the November ballot which would determine how much
outpatient kidney dialysis clinics may charge for patient care. The high
court said the the item may be placed on the ballot.
Danny P v Catholic Health
Initiatives
9th Circ
The self funded group plan refused to
cover room and board coverage for a residential treatment program for mental
health issues. The lower court ruled for the plan and the 9th Circ reversed.
They say that mental health coverage must be the same as med/surg coverage and
to deny residential is improper.
National Institute of Family and
Life Advocates v Becerra
US Supreme Court
The 9th continues to be
overturned. They lost twice on the same day once on immigration and again
on this case. The court said that freedom of speech rules and that clinics
established to persuade women do continue their pregnancies can not be forced to
tell them about the availability of abortion. This over turns a California
law that would have forced the speaking of abortions by anti-abortion
providers.
HIPAA
Lee-Thomas v LabCorp
DDC
The patient was in Providence Hospital
in Washington, DC where she received treatment from LabCorp. She claimed
the public nature of the intake computer station violated HIPAA. She filed
a complaint with the OCR which decided not to pursue the matter so she
sued. The court agreed with the OCR. There is no private right to
sue under HIPAA. Wonder how happy her attorney is?
Hospitals
French v St. Anthony North Health
Jury
Lisa French had back surgery at the
Colorado hospital and was insured. She was part of her employer self
funded ERISA plan and was told she would have to pay $1336 out of pocket.
She paid $1000 immediately. The hospital billed the insurer $303,000 and
they paid $74,000. The hospital then sued her for the remainder.
They used the chargemaster to determine how much was owed and her attorney
argued these were not reasonable charges. The jury came back with a
verdict for the hospital in the amount of $766. The hospital will appeal.
Physicians Regional Medical Group
v NCH Healthcare System
Filed
The group and the affiliated hospital
accuse NCH of stealing physicians. The say the NCH recruited physicians
employed by Physicians Regional after resources were spent to develop mature
practices. The suit says that NCH referred all recruited physicians to an
attorney who said their restrictive covenants were unenforceable. This was
part of the recruitment pitch, says the suit. Since 2012 Physicians says
it recruited seven physicians who were poached by NCH.
Southeast Anesthesia Consultants v
Atrium Health
NC Business Court
The court refused to issue an
injunction against the hospital for hiring a new anesthesiology group. It
did restrict the new group from hiring anyone from the old group until 7/1/19.
Malpractice
Patients v UPMC
Pennsylvania Supreme Court
The state high court ruled that law
suits against the hospital could go forward. The patients sued after they
became infected with hepatitis C after the hospital failed to report an employed
who stole fentanyl. They should have reported him so he could do no harm
at other hospitals but they did not. The suing patients are from hospitals
that he worked after leaving UPMC.
Steniford v Southard
Jury
The patient sued his internist and a
neurologist for not ordering an HIV test on him therefore allowing his HIV to
progress to AIDS. The patient won $18.4 million. He was known to by
gay and worked as a paramedic around bodily fluids.
Anderson v Khanna
Iowa Supreme Court
The state high court ruled the patient
may sue the physician and his employer Iowa Heart Center for med mal since he
did not disclose he had never performed the surgery prior. Post op he was
in a coma and needed a second surgery followed by a heart transplant. The
court ruled that physicians have an obligation to disclose their professional
experience and training if it is material to the decision by a reasonable
person. In the 4-3 decision the dissent stated that the surgeon met the
standard of care in the surgery so not disclosing is immaterial.
Jackson v Providence St. Vincent
Hospital
Filed
The patient is suing the hospital for
not doing an MRI on him because he was too large for the machine. He had
back pain and was discharged following the realization of being unable to do an
MRI. Six days later he was paraplegic from a thoracic epidural
abscess. He is suing for not being transferred to another hospital to
prevent the paraplegia.
Three Families v DaVita
Jury
Three families sued DaVita in federal
court in Denver for wrongful deaths. The patients died after being
dialyzed with Granuflo, which can cause toxic pH imbalances and alkalosis.
The families got compensatory damages plus $125 million each in punis.
DaVita will appeal. The product was never in question and is still in use
as it has been for the last quarter century.
Peer Review and Employment
Grabois v Memorial Regional
Hospital
Filed
During a department meeting where he
was the chief of OB a nurse complained about another physician shoving a
washcloth into the mouth of a screaming patient. He made a comment
"Like Fifty Shades of Grey". He was told to either resign or
have his credentials changed to six months at a time. The Broward County
Medical Association is also backing Grabois for not receiving a fair
hearing.
Mayo v Wisconsin
Wisconsin Supreme Court
In this horrific case the mother of 4
went to the hospital ED with fever and abdominal pain. She was seen by a
physician and a PA and sent home to see her gyne for her fibroids. The
next day she became worse and went to a different hospital ED where she was
diagnosed as septic. She lost consciousness and eventually lost all four
extremities due to Strep A. She sued and won compensatory damages of $8.8
million and $15 million in non-economic damages. The trial court knocked
that down to the state law of $750,000 and Mayo appealed. The appellate
court upheld the original jury decision stating the cap on non-economic damages
was unconstitutional. The Supreme Court over rode that and reinstated the
original $750,000 stating the cap is rational.
Mitchell v Shikora
Pennsylvania Supreme Court (to be decided)
The lower court ruled that physicians
may be liable if the patient suffers a known complication of the correctly performed
procedure. In the underlying case the patient sued the Ob/Gyne for med mal
for negligent in surgery. She did not claim the the physician did not get
informed consent. However, at trial Dr. Shikora said the complication is a
usual one that is performed even if the procedure is performed correctly.
The plaintiff's attorney objected and the judge overruled the objection.
The jury found for the physician. the appellate court said the known risks
were not to be presented in a new trial. The Supreme Court will now make
the ultimate decision.
Employees v Cerner
Settlement
Cerner, after stonewalling for years,
has agreed to pay an undisclosed sum to settle accusations that they illegally exempted
delivery consultants and system analysts fro overtime pay. The suit
alleges these were actually entry level positions.
Physicians
Davis-Boutte v Georgia
Filed
Dr. Wendell Davis-Boutte, the dancing
dermatologist who lost her license after videos of her appeared on line dancing
during surgery and having multitudes of med mal suits against her is suing for
an injunction to the emergency license suspension.
Perry-Bottinger v John Doe
Filed
Dr. Lynne Perry-Bottinger, a New
Rochelle cardiologist, has filed suit against John Doe who posted a bad review
of her on HealthGrades. She believes it is posted by a competitor
physician. She claims the bad revue has caused appointments to be
cancelled and stopped seeing her. HealthGrades will not release the name
of the poster without a subpoena. She wants $1 million. So do all of
us.
Yarus v Walgreen Co
3rd Circ
In what seems poor lawyering an
orthopod sud Walgreens for defamation. They wrongly refused his
prescriptions and told the patients that he was under investigation by the DEA,
not true. This was due to an internal computer malfunction. The
physician's attorney contacted Walgreens and was told the comments in the system
were removed. The comments to patients continued and he sued. The
court rightly threw out the case as it was against the statute of
limitations. When the attorney first contacted Walgreens that is the date
he actually knew about the problem and the attorney nor the physician ever
checked to make sure the comments were removed from the computer system.
Beharie v Citrus Valley Health Partners
Filed
Dr. Carlos Beharie, OB/Gyn, is suing for killing his
practice. He started Citrus OB and eventually got it to a total of five
physicians and the practice was delivering 80-100 patients a month. The
West Covina Partners wanted to buy the practice but the two sides could not
reach an agreement. Soon three of the physicians were working for Citrus
Valley Health Partners. Dr. Beharie saw the handwriting on the wall and
closed the practice. They offered $1million for the practice but got it
gratis.
Wiorek v Children's Hospital of Wisconsin
To Be Filed
Apparently Dr. Lori Wiorek during a staff seminar said to a
black person "do you want to get lynched". It was in the context
of her not agreeing to something that all needed to soon enough. She is no
longer employed at the hospital. The local Black Panthers got involved and
they named the physician.
Archive
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.