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Brookdale Hosp. v Health Ins Plan
NY
Filed
The Brooklyn hospital is suing the HIP for nonpayment of funds and asserting it conspired with physicians to wrongfully deny coverage. The physicians are those that work determining medical reasonableness. They work for the insurance companies who cannot conspire with themselves. The hospital states that some of the denials of care were so bad that they could not have been made by physicians. That may be true and the denials were electronically signed. There were no original signatures. The hospital is also suing its own physician group. This is not a way to get patients.
Tri-City Med Ctr v Aetna
Filed
In a case filed between Tri-City Medical Center in southern California and several insurance companies along with a physician group. the judge has ordered the units get together to attempt to settle the case. Tri-City wants reimbursement for outpatient services. There are over 2000 unpaid services. The problem was the physician group was stupid enough to sign an all inclusive contract with the insurance companies. This means they get a fixed amount per month per patient and out of this they must pay the hospital as well as the physicians and employees. One insurer also paid the cap rate to the hospital for inpatient care and anything left over was to be paid partly to the physician group. This was not paid. The physician group stated that the hospital waited too long to bill and so is no longer owed the money.
Ca. Realtors v Blue Shield
LA Superior Ct.
A judge has allowed Blue Shield to drop health insurance for the California Assn. of Realtors. Blue Shield has argued that the Association had been in breach of contract for failing to enroll enough members in the plan. There was a minimum in the contract. Blue Shield members were told that they could still join Kaiser or bet insurance via COBRA, both poor alternatives.
Patients v Blue Cross
Filed
In this case filed a while ago the California Medical Association and the California Hospital Assn. has joined the plaintiffs. The regulators, patients, physicians and hospitals are all against the insurer for canceling the individual patient's insurance if they get costly medical care. The insurance is cancelled retroactively. The insurer is defending on the fact that preauthorization is not a guarantee of payment. They state they are rescinding the patient's contract for fraud and not the preauthorization.
In the long standing suit between physicians and Blue Cross, Blue Cross has agreed to pay up. This is the case in Miami where the Blues were accused of intentionally not paying claims and delaying payments for their own gain. The Blues continue to deny they have done anything wrong and are willing to pay $128 million to the physicians and an additional $49 million to the physician's attorneys for doing nothing. Most would pay that for doing nothing wrong. Top
Texas v CVS
Filed
Texas has filed against CVS Pharmacy for violating a Texas law protecting customer's information. CVS apparently dumped about 1000 customer's personal medical and financial information into a garbage container. This was in Liberty, Texas. The fine can be $50,000 per record under one code section being charged and $500 per record under a second code section.
Patients v UCSF
To Be Filed
The University of California at San Francisco has lost due to computer theft the personal health information of about 3000 people. The individual affected have been notified. Top
Irvine v UC Irvine
Ca Ct Appeals
The California Court of Appeals overturned a rejected suit from two years ago regarding the negligence and fraud of the University's liver and renal transplant programs. The reason for the suit being given summary judgment to the University two years ago was the settlement payment of $50,000 to Irvine. The check was never cashed and the court was asked to overturn the settlement. The lower court refused and the Court of appeals has now overturned that decision. The trial will proceed. Irvine also sued her attorney at the time for pressuring her to accept the settlement.
Spillman v SW La Hosp
WD La
This is another poor judgment by an attorney. The attorney did not know the law and sued the hospital for an EMTALA violation and malpractice under the EMTALA statute. The patient had abdominal pain and had a CT scan that was misread by the radiologist. The patient had a ruptured appendix. The court stated that all similarly situated patients get CT scans so no violation of EMTALA. Malpractice may be present but not under the EMTALA statute since the law is not a federal malpractice statute. It is hard to believe that the attorney would file an appeal on an elementary law.
Low v Henry
Texas Supreme Ct.
Henry, an attorney, filed a law suit against Dr. Low for medical malpractice the same day he filed a motion to withdraw as the attorney for the plaintiff. Attorney Henry forgot to read the medical record which is against the Texas statute that allows sanctions against an attorney that files without reasonable basis in fact or law. The trial court found Henry guilty and allowed $50,000 in sanctions. This was overturned by the Ct. of Appeals and then that decision was overturned by the Supreme Court. The attorney had the records for months and never looked at them. The Supreme Court sent the case back for the trial court to explain its actions and to add costs and fees to the decision.
Patients v AportheCure
To Be Filed
Three people have died due to a mistake at the compounding pharmacy. The compounder made the dosage of Colchicine 10 times what it should have been. Top
Gonzales v Planned Parenthood
US Supreme Court
In a 5-4 decision the majority allowed a ban on partial birth abortion. This overturns a similar case decided in 2000 prior to the Congress legislating a new ban on the procedure. The new law allowed much narrower limits for the procedure. The ruling allows physicians to know exactly what they will expect if they do the procedure. They will get two years in prison, fined and banished from Medicare. Prior laws were not as specific as to what physicians were in for. This does not overturn any prior pro choice laws except as related to this procedure. It is probable that some states will now put the law into effect. Top
Lobel v Maimonides Med Ctr.
NY App. Div.
The physician was an at will employee for the hospital. She received a letter extending her employment but then had her privileges revoked. The court ruled that she could only sue for injunctive relief and not for damages. The employment letter did not mention privileges.
Mixon v Ibernia Surgical
La Ct. App.
Mixon was terminated by Ibernia after Mixon as one of the founding members believed Ibernia was violating Federal law in connection with the treatment of Medicaid patients. The trial and the Court of Appeal both agreed that Dr. Mixon had no cause to complain. He was paid for his share and for his services. He wanted more money. The courts did not agree he was entitled to more money nor that he had any viable causes of actions.
Millsaps v Ohio Valley Heartcare
Ind. Ct. App.
The physician was an employee, shareholder and director of the Corporation. There was a non- compete clause in the employee agreement. The physicians resigned and sought an injunction to forbid the non compete as against public policy. The physicians accused the Corporation of faulty billing and collection procedures which created a $2 million past due account receivables. The low court upheld the non compete but restricted its terms. The court of appeal reversed and stated that since the corporation breached a material part of the contract and could not enforce the covenant. It also found important that eight of the 15 physicians had left due to the corporation's non billing. Top
Drew Med School v LA County
Filed
In a ridiculous suit, the Drew Medical School is suing the Los Angles County for $125 million for taking away their accredited training hospital. They seem to forget that they had a significant role in having the King Hospital go bye bye. This is equivalent of a child killing his parents and then throwing himself on the mercy of the court for being an orphan. Top
Indiana v Kasim
Filed
Dr. Jihad Kasim of Valparaiso, Indiana, was arrested for Medicaid fraud. He was accused of stealing files from a hospital and fraudulently billing for care never received by the women. He apparently billed for over $1 million in services never performed. The prosecutors have frozen three bank accounts, attempting to seize three cars, two homes and a speedboat.
US v Loma Linda
Settlement
Loma Linda is back in the not so good news. This time it is their Behavioral Health Medical Center that has settled false billing charges. Top
In re Basco
Texas Supreme Ct.
The Texas high Court stated that a hospital that used an attorney that had a conflict of interest in a peer review case could not be used. The case was tossed and must be reheard with the hospital using a different attorney firm. 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.