February 15, 2023 Recent Legal News
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US v Kahn
10th Circuit
Dr. Shakeel Kahn was serving a 25 year sentence for over prescribing opioids when he won his appeal at the US Supreme Court. The high court said that the jurors were wrongly instructed on how to determine whether he prescribed the drugs illegally. The 10th Circuit then overturned the conviction.
Patient v Gronbeck
Filed
The first of what I am sure is many civil suit has been filed against Ohio physician Dr. Donald Gronbeck. He will be tried starting in September on 50 charges of alleged sex crimes. He is currently on house arrest.
Ohio v Sutton
Guilty
Dr. Jeffery Sutton of Niles, Ohio, plead guilty to charges he over prescribed opioids without a medical reason. He allegedly also traded opiates for sex.
Maryland v Malek
Arrested
Dr. Istaiq Malek of Montgomery county ws arrested for allegedly sexually assaulting two women at his Urgent Care center. Top
US v Patino
Sentenced
Dr. Francisco Patino of Woodhaven, Michigan, was sentenced to 16.5 years in prison and pay restitution of $30.3 million for his part in a health fraud scheme. He maintains that he is innocent. He was convicted of fraud and paying and receiving kickbacks. He was accused of prescribing large amounts of narcotics and subjected people to unnecessary medical procedures to get the narcotics. He then billed for these procedures. The conviction is to be appealed.
US v Jackson
Convicted
Dr. Anita Jackson, an ENT in Raleigh, North Carolina, was convicted of billing for her re-using of a balloon dilator for office sinus surgeries. She also did not collect the required co-pays in order to get more of these surgeries.
US v Lund
Guilty
Dr. Marion Lund, DPM of Mississippi plead guilty of fraud. He was accused of writing prescriptions for antibiotic and antifungal meds on a routine basis and then have his pharmacy fill these meds. He also sent toenails for unneeded testing in exchange for bribes.
US v Reheja
Sentenced
Dr. Deepak Raheja of Hudson, Ohio, was sentenced to 30 months in prison and ordered to pay a $50,000 fine and restitution of over $2 million along with loss of his medical license. He was previous convicted of receiving kickbacks to prescribe Nuedexta. He received only $300,000 in kickbacks but wrote over 10,000 prescriptions for the drug
US v Frances
Sentenced
Joshua Frances of Falmouth, Maine was sentenced to five years in prison and restitution of $87,000 plus forfeiture of a 27 foot Boston Whaler boat along with two motors and a trailer. He had plead guilty of fraud for converting the boat and other things to his use illegally.
US v Clinica Sierra Vista
The clinic has agreed to pay $26 million to settle allegations that they underreported income which is false reporting in violation of Federal and California laws.
Indiana v SEMC , Chand
Settlement
The Hammond Medical Center run by Dr. Kishan Chand agreed to pay the state $700,000 to resolve allegations that there was overbilling of the Medicaid system. They billed for spinal manipulation under anesthesia but there was no associated billing for an anesthesiologist or a hospital or surgical center.
US v Patel
Indicted
Dr. Sangita Patel of Oakland County, Michigan, was indicted on healthcare fraud. It is alleged that she submitted bogus claims to Medicare by billing for telehealth services she did not do. It is also alleged that she prescribed controlled substances to about 90% of the patients in her telehealth claims.
US v Cornerstone Healthcare Group Holding Inc.,
Cornerstone Hospital Medical Center
Settlement
The Texas company agreed to pay $21,637,512 to resolve allegations that they billed for unauthorized services, services not provided and services so bad they were deemed worthless. The company was a long term facility in Houston and is now not in business. The holding company operated specialty hospitals throughout the country. This is a whistleblower case and the former employee will get over $4 million.
Relators v Laboratory Corporation of America Holdings (Labcorp)
Settlement
LabCorp has agreed to pay $19 million to settle allegations that they participated in a scheme to bill Medicare for blood draws tainted by physician kickbacks. It was alleged that phebotomists drew blood in physician offices when the physicians were getting processing and handling fees from other labs. The US did not intervene in this case so the money and the relators get almost 30% of the recovery.
Illinois v Spadoni
Indicted
The prior COO of Rush Oak Park hospital allegedly illegally caused the hospital to contract with a company that his family and he founded.
US v Florida Cardiology PA, Bajaj, Reddy
Settlement
Drs. Sandeep Bajaj and Karan Reddy along with Florida Cardiology agreed to pay $ 2 million to settle allegations of falsely billing Medicare for procedures done while they were not in the country and billing for services that were exaggerated or not performed by qualifying physicians.
US v Patel
Guilty
Dr. Sauabh Patel of Newark, New Jersey, plead guilty of healthcare fraud for writing prescriptions for compounded meds not needed.
US v Luketch UPMC Univ. of Pittsburgh Physicians
Settlement
The two entities and Dr. James Luketch, the longtime Chair of CV Surgery, agreed to pay $8.5 million to settle allegations that they billed for concurrent surgeries performed by Dr. Luketch where he was not present for the "key and critical" portions of the surgery. This is a whistle blower case by a fellow surgeon. Top
Trinity Health v Orthopedic
Associates of Michigan
Filed
The hospital is suing the pods for being a monopoly in Kent County, Michigan. Several surgeons wanted to leave the ortho practice to become salaried employees of the hospital but ran afoul of the noncompete clause. The clause forbids practice in a 50 mile radius for one year. The suit is stupid as they will not go to trial for well over one year in which time the non-compete will no long be effective.
Texas Medical Association v CMS
Ruling
A federal judge in Texas has sided with the TMA and hospitals against CMS in the No Surprise Act. He stated that the arbitration process was flawed even after the rule was changed in 2021. This is the second time the Association has gone against HHS on this issue and won. There are now two other suits pending by the TMA against HHS on this issue.
ACS Primary Care Physicians
Southwest v UnitedHealthcare
5th Circuit
The ED group sued in federal court for not being paid their usual and customary fees under the Texas "Emergency Care Statue". The district court ruled that they could sue but the 5th overruled the district after they certified the question to the Texas Supreme Court which ruled there was no private right to sue. Top
Patients v Katherine Shaw Bethea
Hospital
Settlement
The hospital has agreed to pay up to $250 to all who were sent bills that were meant for others.
HHS v Banner Health
Settlement
Banner Health agreed to pay a fine of $1.25 million and sign a consent agreement for their poor performance in HIPAA. They did not do the required security work required and as a result allowed hackers to get information on 2.81 million people. Top
Smith v Mercy Hospital, Henson
Jury
Smith went to the Maine hospital to see Dr. John Henson for a rash, fever, chills, dizziness and headaches. At the end he needed to be transported to the hospital via ambulance where he was finally diagnosed with Lyme Disease and Lyme carditis from which he died. The hospital and physician was ordered to pay $6.5 million for the missed diagnosis.
Lee v Scripps Mercy Hospital
Filed
Lee was a 27 year old special needs woman who died allegedly after eating a peanut butter sandwich. She was allergic to peanut butter. A note in the chart relates the two. Top
Physicians v Delta County Memorial
Hospital
Settlement
Three female physician at the hospital sued for violation of the Equal Pay Act saying they were paid less than their male peers with less qualifications. The physicians were all terminated after complaining. The settlement which was not revealed must have been substantial as the case was dismissed with prejudice.
Bowden v Houston Methodist
Hospital
Dismissed
A federal judge dismissed the $25 million suit and ordered Bowden to pay attorney fees. She had sued the hospital for defamation after the hospital suspended her for using her social medial to spread Covid misinformation. She says she will appeal.
Mooney v Emory University
Filed
Dr. James Mooney is an anesthesiologist who was investigated for sexual harassment for making inappropriate comments to a fellow physician. One month later he was removed as director of pain services and had a pay cut. Two years later he was exonerated and he is now suing for anti-male bias and screwing up the investigation. 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.