May 15, 2016 Recent Legal News




Peer Review and Employment




US v Wilson

Dr. Wayne Wilson of Hickory, North Carolina, was sentenced to one year in jail and the payment of $208,112 for restitution to Medicaid and $2148 to Medicare.  He billed for services never provided.  

US v Adebimpe
9th Circuit

In a 2-1 vote the 9th decided that Patrick Sogbein and his wife, Adobola Adebimpe should get enhanced criminal sentences for health care fraud.  They paid physicians to order electric wheelchairs and billed the feds for them.  Them patients did not need the medical products.  The court said they had professional or managerial discretion and therefore deserved the enhanced sentencing.  The lone dissenter said that they did not since the physicians are the ones that said the patient needs the type of chair and they just followed his directions.

US v Roy

Dr. Jacques Roy of Dallas was found guilty by a federal court of healthcare fraud.  It was shown that his company fraudulently approved 11,000 Medicare folk for home care from 500 hone health agencies in five years.  The home visits were not necessary and cost the feds over $375 million.  His company had received over $19 million from the feds.  This shows that crime does not pay and the feds are worthless in preventing fraud.

Michigan v Altantawi

Dr. Bassel Altantawi of Farmington Hills, Michigan, was charged with health care fraud for billing for services not rendered.  

US v Wijegoonaratna

Drs. Sri Wijegoonaratna and Boyao Huang of the Pasadena area were convicted of health care fraud for fraudulently certifying Medicare patients were terminally ill and qualified for hospice when they were not dying.  They will each get at least the mandatory 10 year in prison.  Four others have already plead guilty.  

FTC v PinnacleHealth
District Court

A judge has disallowed the FTC from interfering with the merger of Milton S Hershey Medical Center and PinnacleHealth.  The FTC said the merger would control almost 2/3 of the hospital market in four counties which may lead to increased costs.  The judge ruled no preliminary injunction against the merger since the FTC failed to meet its burden that it would ultimately succeed.  Watch for an appeal instead of the usual slithering away.

US v Kiraly

Dr. and Mrs. John Kiraly of Lodi, California, have agreed to pay $300,000 to settle claims that the oncology practice purchased drugs from an unlicensed foreign pharmaceutical distributor and billed as if they were approved drugs.

US v Brasfield 

Bridget Brasfield, DC of Granite City, Illinois has pled guilty to health care fraud.  She billed the feds for services by a medical physician and services not rendered. 

US v Khan

 The feds indicted three physicians for selling drugs illegally.  They are Drs. Azad Kahn, Keyhosrow Parsia and Alan Summers all of the Philadelphia area.  They are accused of selling the drugs Suboxone and Konopin for money without any exams.

US v Kinnealey

Evanston, Illinois oncologist Ann Kinnealey agreed to give up her DEA and Illinois licenses due to using non-approved cancer drugs.        Top


Baum v Keystone Mercy Health Plan
Penn App Ct

The court upheld the lower court in tossing the class action claims for the plan's losing a flash drive with the information of over 200,000 people.  The courts denied the class certification since there was no demonstrated link between Mr. Baum and the information on the lost drive.  Therefore Mr. Baum could not represent the class.  

Patients v Saint Agnes Medical Center
To Be Filed

The Fresno, California, hospital was vandalized in a phishing that got the data of all people employed by the hospital in 2015.  

Patients v Ohio
To Be Filed

The Ohio Department of Mental Health screwed up.  The sent postcards to 59,000 people asking them to participate in a survey.  Patient names and addresses were exposed along with their connection to mental health services.  The request should have been sent in sealed envelopes.

Patients v Unity Point Health-Allen Hospital
To Be Filed

The Waterloo, Iowa, hospital found late that a past employee had accessed 1600 medical records without authorization or need.  

Tam v Diakos

Dr. Maria Tam filed a suit for emotional distress by illegally accessing her electronic medical record against Drs. Barbara Diakos and Rose Diakos as well as the Lakeshore Women's health Specialists.          Top


Horvath-Cooper v MedStar Washington Hospital Center

Dr. Diane Horvath-Cooper file a complaint with the OCR that the hospital is doing  what she claims is an attempt at muzzling her free speech rights.  She is an advocate of abortion and she says the hospital forbade her to speak publicly in defense of abortion and its role in health care.  The hospital did not want a spotlight on the fact that they do abortions.  They now have a huge beacon. They have ordered her to turn down several requests for interviews or articles or risk losing her position.  

Planned Parenthood v Kansas

Planned Parenthood has be defunded by the state by removing it from the Medicaid roster.  This was done by an order of the Governor for noncompliance with laws, administrative regulations or with laws or with providing medical provider information; non compliance with provider agreements: unethical or unprofessional conduct; and other good cause.  The PP Overland Park would not allow state waste inspectors complete an inspection even with a subpoena. 

House of Representatives v Obama

The House has won the first round in this war against Obamacare.  The judge ruled that the administration could not use general funds to pay for the Obamacare cost sharing.  This is due to the lack of funding by the Congress.  The court ruled the law appropriated funds for tax credits but did not allocate the funds.  The appropriation of the funds can not be inferred.

Stinson v Kaiser

In another case of a toddler declared brain dead who the parents do not believe is dead since he still breaths on a vent.  This case unlike the McMath case earlier does not involve malpractice by the hospital.  The boy was seen in a Mercy Hospital ED and then at UC Davis where a respiratory event led to a cardiac arrest.  He was declared brain dead there but transferred to Kaiser in Roseville for a second opinion.  The Kaiser physicians also declared him brain dead on several occasions and want to disconnect his ventilator.  The parent object and are suing in federal court to have a breathing tube and feeding tube inserted so he can be transferred to yet a different hospital probably in New Jersey.        Top

Peer Review and Employment

Goodrich v Sierra Vista Regional Med Center
Ca Ct App

Dr. Karen Goodrich has been declared a vexatious litigant.  After being terminated from the hospital and not showing up at the peer review hearing she lost her membership.  she and her attorney filed a writ of mandamus but when she lost she did not appeal.  The attorney dropped her and she has filed in propria persona five unsuccessful motions challenging court decisions.  The hospital finally had enough and sued her.  The trial court ordered a $25,000 bond to proceed and prohibited her from filing anything against the hospital without the leave of the court.  She appealed and again lost.

EEOC v Mission Hospital

The fed agency filed a complaint against the Asheville, North Carolina, hospital for firing three workers for failing to get a flu vaccine shot.  They had rejected the shot due to religious concerns.  The EEOC wants permanent injunctive relief as well as back pay, compensatory damages punitive damages and reinstatement or front pay.

UMC Physician Network v Leins
Texas App Ct

Great case to show how one wins but loses.  The physician won a jury verdict of $9,000 for lost income in the past and $100,000 for loss of future income.  The physician whistleblower alleged he was terminated against grievance procedures.  The hospital appealed and the court agreed with the physician but took away his $100,000 future damages.        Top


Flores v Presbyterian Intercommunity Hospital
California Supreme Court

Flores sued the hospital for premises liability and negligence for falling after a side rail on her bed collapsed and she fell to the floor.  She sued after the one year statute for med mal.  The court ruled for the hospital in summary judgment but the case was reversed on appeal to the Court of Appeals.  The Supreme Court reversed the Court of Appeals and said the physician has assessed the patient and ordered the side rails therefore it was a medical decision and barred by the statute of limitations.

Ristesund v Johnson and Johnson

The patient sued the company after getting ovarian cancer.  She contended that using the company's talc powder for feminine hygiene was the cause.  The jury voted to pay the plaintiff $55 million.  The company has been accused of not warning that talc was linked to an increased risk of ovarian cancer.  A prior case in February awarded a woman $72 million.  A case in South Dakota found J&J negligent but awarded no damages.  J&J will appeal all verdicts.

Patients v Huntington Hospital

At least three patients died last year at the hospital due to tainted medical scopes.  The scopes are from Olympus and the hospital is mum on all information.  A FDA report shows they died of septicemia from pseudomonas after being scoped.

Allen v Harrison
Oklahoma Supreme Court

The patient came to the ER after swallowing a nail.  The ED physician said to let it pass spontaneously and did not give the patient any other choices.  The nail punctured the intestine and the patient needed surgery to remove the nail.  The suit was for lack of informed consent based on failure to disclose potential risks.  The trial court gave the physician a summary judgment.  The high court reversed saying that consent was not only for surgical procedures but for noninvasive sanctions as well.  The physician should have told the patient about surgical removal as well as the risks of the natural passage.  

Mikeska v Las Cruces Regional Med Center
New Mexico Ct App

The patient came to the ED twice in one day and was diagnosed with a ruptured ovarian cyst and sent home.  She had a bowel obstruction diagnosed four days later.  She sued for an EMTALA infraction and lost in the lower court.  The court of appeal reversed due to errors of the district court allowing and not allowing some testimony.  The summary judgment will be re-heard.

Navo v Bingham Memorial Hospital
Idaho Supreme Court

The state high court vacated and remanded a summary judgment finding in favor of the hospital.  The patient broke his ankle, had surgery, became infected, had a second surgery and died from an adverse reaction to anesthesia.  A suit was against both the hospital and the nurse anesthetist.  The hospital said the nurse was an independent contractor and therefore they needed summary judgment.  This was granted.  The Supremes said the initial consent form said only that the physician anesthesiologists were independent contractors but was silent on the CRNA.  The anesthesia consent form was silent as to the independent contactor status and addressed only billing issues.  Therefore summary judgment was inappropriate.

Kennedy Health Systems v Darwin national Assurance Co.

The underlying claim of Fleming versus the hospital is for burning the patient who has no feeling due to paraplegia.  He is suing for more than $3.5 million.  The hospital notified their insurance carrier Princeton of the claim.  Princeton told them that the claim may be over their $1 million limit.  The hospital then notified Darwin who covers the hospital for up to $10 million after Princeton pays the first million.  Darwin denied the claim since the hospital notified them too late.  The suit was then filed.  

Rivers v Yorkville Endoscopy

The daughter of Joan Rivers has settled the law suit against the outpatient facility and the physicians involved in the death of her mother.  She has apparently received many millions of dollars and apologies from those involved.  This cane even before the deposition stage.

Thornhill v Jackson Parish Hospital

The patient Cotherman had shortness of breath and presented to the ED of Jackson Parish Hospital.  He was admitted but the family wanted him transferred to to St. Francis Medical Center.  The patient was transferred but had problems during the transfer and was diverted to North Louisiana Medical Center where he died.  The family sued for EMTALA violations by not providing an appropriate transfer and appropriate medical personnel and equipment were not provided.  The court ruled with the majority of decisions that EMTALA obligations stop when the patient is admitted.

Horton v Oregon Health and Science University
Or Ct App

The trial court ruled the plaintiff mother was not a foreseeable plaintiff and dismissed the case.  The court of appeal reversed.  The facts are the hospital committed malpractice on the infant son by assigning an inexperienced surgeon to do a liver transplant.  This directly led to severe complication in the infant and the need for an emergency matched donor.  The mother volunteered and was injured.  She, the appellate court ruled, was a foreseeable plaintiff.        Top


Tenet Healthcare v Eisenhower Hospital 
Ca Ct App

A patient insured by Eisenhower came to the Desert Hospital owned by Tenet for a motor vehicle accident.  Desert is a trauma center.  Desert promptly notified Eisenhower and was told that coverage was available.  Over $1 million later Desert was told no money would be paid since the patient had a BA over .2 which negated the coverage.  Tenet had never been told of the provision.  The trial court allowed a demur by Eisenhower without leave to amend. In a blow for sensibility Eisenhower lost the case and the case goes back to the trial court for trial.        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.