March 1, 2009 Recent Legal News




Peer Review

End of Life





US v del Cueto

Drs. Carmen Lourdes del Cueto, Roberto Rodriquez and Carlos Garrido the owners of Midway Medical in Miami, Florida, have been charged with Medicare fraud for ordering medically unnecessary treatments for HIV positive patients including procedures never performed.  Three others were accused of helping the physicians with the scheme. 

US v Sanders

Walter Sanders, the owner of Waitco Medical in Memphis, for Medicare fraud.  He obtained illegal inside information from his wife, a secretary at a hospital and submitted false claims.  He was sentenced to 60 month in prison and will need to repay $600,000.

US v Chen

Dr. Eugene Chen, a Los Vegas anesthesiologist, was convicted of Medicare fraud.  He submitted about 3500 false claims for consulting services never performed.  He will also be fined at a later date up to $1.26 million with treble damages.   

US v Brigden

 In the December 13, 2008 edition I reported that Dr. Brigden generated bills for services never rendered.  Dr. Brigden maintains that he was a salaried employee and that all bills were generated by a clerk.  The original press release by the Feds on December 8,2008, states that "The Settlement Agreement includes a provision stating that the agreement does not constitute an admission of liability by Dr. Brigden.  At the same time, the United States does not concede that its claims are not well founded."  In my February 1, 2009, comments on Dr. Brigden's comments to my original story, I  stated that he had been convicted.  This was an error for which I apologize.  

Mississippi v Pulsifer

Aaron Pulsifer was sentenced to 20 years in prison for Medicaid fraud.  He fraudulently obtained a provider number and children's numbers.  He then billed for treatments and gave the children phony diagnosis.

US v Sloan

 Joel Sloan of McCalla, Alabama was sentenced to 18 months in prison and restitution of $71,000.  He was convicted of forging physician approval documents for DME.

US v Soto

Jimmy Soto of Miami Lakes. Florida was sentenced to 140 months in prison for a DME fraud scheme.          Top


NY v Cigna

The attorney general of New York continues to get results against the insurers that utilized the infamous United Ingenex methodology to screw patients and physicians who saw HMO patients out of network.  Cigna has agreed to stop using the discredited format and contribute $10 million to the formation of a new fair format.  Mr. Cuomo also intends to sue Blue Cross Blue Shield Excellus for the same thing.  Wellpoint has also agreed to a settlement and a payment of $10 million. It should be interesting how this affects California and its new out of network rules.  It should mean significant money for the hospitals and physicians involved.

AMA has now joined into the suit as a johnny come lately.  As usual, they follow and do not lead.  They added their name to a physician led suit against the insurers for return of money owed due to the faulty Ingenex program.       Top


Patient v U of Chicago
To Be Filed

The University of Chicago along with a few other hospitals in the US have had it with seeing patients in the ED that are not emergencies.  The University has a second place for non emergencies to be seen.  The patient is supposedly triaged in the ED by a nurse and then sent to a different area if an emergency is deemed not to exist.  In the case at hand a child had a significant part of his lip removed by a pit bull.  After waiting for three hours for the triage there was deemed no emergency and the patient discharged.  The patient was late admitted to Stroger Hospital (Cook County Hospital) for treatment.  The child is on Medicaid.  The hospital version and the mother's version of the University of Chicago incident are at polar ends. The American College of Emergency Medicine has also weighed in against the use of a second area for seeing non-emergency patients.  They may be seeing less income so their comments are to be taken with a grain of salt.  However, the dual treatment facilities are a product of Michelle Obama and so one needs to be on the lookout for how that affects treatments and payments.

OIG v St. Joseph Hospital

A federal judge gave a $50,000 fine, the largest possible, to St. Joseph Hospital in Stockton, California.  The case was an 88 year old man who waited in the ED for about 3 hours without being seen for even triage and then dying in the ED.        Top

Peer Review

Baptist Health v Murphy
Arkansas Supreme Court

In one of the most watched cases of the past five years Baptist has lost again.  They have been permanently enjoined from the removal of the cardiologists from their staff and enforcing their economic credentialing policy. This hopefully ends the long and grueling case and lets other hospitals be more circumspect in their use of economic credentialing. 

Savarirayan v White County Hosp
MD Tenn

Dr. Savarirayan entered a recruitment agreement with the hospital but this had later irreconcilable differences between the parties.  The hospital let the physician go but also forgave him his repayment of $261,000 in exchange for a promise not to sue the hospital.  The physician then sued the hospital in state court and lost.  He then filed the same case in federal court.  This was rightly tossed for already have been decided (res judicata).  He did all this per se when no attorney would take the case.  I hope he lost alot of time and money.    

Yancey v Weis
Minn. Superior Ct.

Dr. Yancey was a patient's expert witness in a med mal case against Dr.  Weis.  After the case was over and Dr. Weis lost, he and his expert witness complained to the American Academy of Ophthalmology that Dr. Yancey's testimony was misleading to the jury.  Dr. Yancey sued the two physicians that complained about him for defamation.  The jury agreed with him and awarded him $350,000.    Top

End of Life

In re DLH
Pa Superior Ct

DLH is a 50 year old male who has been incompetent since birth.  He needed a vent and the parents petitioned for removal of life support.  This was denied since the patient was not in a persistent vegetative state, had no life ending illness and most importantly the parents although guardians did not have the power to decide as his health care agents under Pennsylvania law unless they could show by clear and convincing evidence that this would be in his best interests.  This they could not do.        Top


FTC v North Texas Specialty Physicians
US Supreme Court

The Supreme Court has turned down the appeal by the physician group of the decision by the 5th Circuit.  That court ruled that the messenger model that the IPA used was inherently suspect and illegal price fixing.  The key was the use of a vote on the minimum price that was needed prior to sharing contact offers.        Top


Rehman v Stony Brook

Dr. Rehman was employed by Stony Brook hospital.  He sued for failure to promote, wage discrimination and retaliation.  He lost the failure to promote on the statute of limitations and would have lost his wage case for the same reason except Obama just signed into law the Ledbetter Act giving long time to sue for wage discrimination.  He also won the summary judgment on the retaliation claim since the hospital's alleged conduct was sufficient to meet the retaliation standard of the Civil Rights Act.    

Tuii v Brigham & Womans Hosp

Dr. Tuii, a female neurosurgeon sued both the above hospital and the chief of neurosurgery Dr. Day for sexual harassment and retaliation.  She won $1.6 million.  One million dollars was for the harassment and the $600,000 was for the retaliation.  The retaliation was due to the hospital making her see an outside physician to make sure she was fit to continue practicing due to her complaining about the harassment.  Dr. Daly is personally responsible for $20,001 for interference.  The hospital is responsible for the rest.  Dr. Tuii continues at the hospital.  Neurosurgeon chiefs seem not to learn from the past.  The same thing happened years ago at Stanford, with the same result.      Top


Patients v Advocate Health

A judge has agreed to the settlement between the patients who sued Advocate in a class action and the system.  Approximately 40,000 patients may get refunds for overpayments to any of the Advocate hospitals that occurred between November 1, 2001 and December 31, 2008.  The total cost will be about $3.5 million.  

California Fines Hospitals

 California's Department of Public Health has fined ten hospitals in the state for unsafe practices. Each was fined $25,000. The following are the ten hospitals: Anaheim General, Bakersfield Memorial, Fountain Valley, Mad River, Marin General, Northbay Vacaville, Scripps Mercy Hospital, Thousand Oaks Surgical, Ventura County and Western Medical.     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.