November 1, 2019 Recent Legal News
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Maryland v Torres
Non-Dismissal
Dr. Ernest Torres will have to stand trial on rape and sex abuse along with second degree assault. His attorney attempted to have the case dismissed because it was based upon information released by the state Medial Board which was supposed to be confidential. the state successfully argued that the information would have been available later in any case. The judge did rule that the trial on the later added charges would be a separate trial.
Pennsylvania v Ortega
Filed
Rachael Ortega of West Chester was arrested for practicing nursing without a license. She pretended to be a hone health nurse in a fake company.
Iowa v Butikofer
Guilty
Lonnie Butikofer, teh prior CEO of Regional Medial Center plead guilty of felony theft. He was accused of stealing $256,000 of the hospital money for personal use.
US v
Aachi
Sentenced
Dr. Venkat Aachi of Saratoga, California, was sentenced to two years in prison for selling narcotics without a legitimate medical reason. He operated a pain clinic in San Jose. Top
US
v Kistner
indicted
Michael Kestner along with Brian Richey, Daniel Seeley and Jonathan White were charged with conspiracy to commit healthcare fraud. They operated pain clinics Pain MD in the Tennessee area and billed for medically unnecessary procedures.
California
v Sutter Health
Settlement
In a huge surprise Sutter reached an agreement with Californai and self funded employers in an antitrust case. The trial had not yet started. The settlement was not announced but will be in early 2020.
US
v UTC Labs
Settlement
The New Orleans company agreed to pay $41.6 million and its three principals agreed to pay an additional $1 million to settle allegations that the violated the False Claims act by giving kickbacks for sending labs to them and billing for tests not medically necessary. This was a whistleblower suit so big bucks to the blowers.
US v Eby
Guilty
John Eby, RN of Fair Oaks, California, plead guilty of paying and receiving kickbacks for home health companies. He was a nurse case manager for a Sacramento hospital so referred cases depending on who paid him.
States
v J&J
Settlement
The company agreed to pay a total of $117 million to settle all claims that they deceptively marked transvaginal surgical mesh devices. There are still four states who did not settle.
US
v Lee
Guilty
Dr. Donald Lee of Temecula, California, was found guilty by a jury of falsifying tests to show venous leg abnormalities and then operate on patients to correct these abnormalities. He also reused single use catheters and upcoded.
US
v Wellendorf
Settlement
Dr. Tracey Wellendorf, a Caroll, Iowa, ENT, agreed to pay $1 million to settle allegations that the doctor performed many operations on Medicaid patients that were improper because they did not meet that standard or incorrectly coded.
US v
Traverse Anesthesia
Settlement
The anesthesia practice and six anesthesiologists agreed to pay $600,000 to settle allegations that they billed for procedures that they medically directed but did not meet the requirement.
Ross
v Group Health Cooperative
Filed
A former business manager has sued the Seattle insurance plan for bilking Medicare by claiming patients were sicker than they actually were and for billing for false medical conditions. The Justice Department is investigating.
US
v Desu
Convicted
The IRS came after and convicted Rao Desu of Piscataway, New Jersey, o defrauding the Service. He owned several pharmacies and skimmed the profits as salary without taxes for he and his partner Darshna Desai.
US
v Osteo Relief Institutes
Settlement
Seven Institutes and their owners agreed to pay $7.1 million to settle allegations that they billed Medicare for medially unnecessary knee braces and viscosupplementation injections including material illegally imported.
US
v Home Health
Settlement
Five home helath compnaies are ordered to pay a total of $3.1 million to settle claims that they submitted false claims to Medicare for therapy services. The five are Sergeant Bluff, Red Oak and Logan Healthcare all of Iowa along with South Dakota Elk point and Flandreau Health care.
US
v Pellegrino
Sentenced
Raymond Pellegrino, DC. was sentenced to 18 months in jprison for fraud. The Long Island Chiropractor was previously convicted of billing for services not provided.
US v Good Days
Settlement
Two Boston charities will pay $6 million to resolve allegations that they were shills for the pharmaceutical industry paying patients to use the high price meds. Good Days along with Patient Access Network Foundation helped to pay out of pocket costs for meds. good Day is paying $2 million and Patient Access the remaining $4 million.
US
v Sanford Health
Settlement
Sanford Health has agreed to pay $20 million to settle allegations that it knowingly submitted false claims for procedures done by a neurosurgeon who was implanting devices from his own distributorship.
US
v Byrns
Guilty
David Byrns of Lighthouse Point, Florida, plead guilty of helath care fraud. He was the former CEO of Putnam County Memorial Hospital in Unionville, Missouri. He and another managed the rural hospital and got an illegal contract to do urine tests on patients not of the hospital.
US
v Outcome Heath
Settlement
Outcome Helath agreed to pay $70 million to settle allegations that it selling advertising inventory that it did not have. The Chicago provider of information and advertising misrepresented to its clients the quality and quantity of its advertising. Top
Tulare
Pediatric Health Care Center v California
Ca Ct App
The judge ruled the Medicaid program must pay the federally qualified health centers for service to their beneficiaries. In this case the Center hired a physician who charged $106 per patient visit. The Center added this cost to their charges to the state Department of Health. On audit the state found that on occasion the physician costs of providing services were less than $106 and contended that the payment should be on actual not billed costs. The trial court and the court of appeal both ruled for the Clinic.
States
v HHS
9th Circuit
The court ruled that the administration rules that employers with religious or moral objections may opt out of Ocare's requirement to provide birth control is not enforceable. This is the third court to block the rules. this sets up another Supreme Court case.
Common
Ground Health Care v US
US Court of Federal Claims
The court ruled that insurers in the suing class are entitled to $1.6 billion since the feds did not reimburse them the total amount due for reducing members cost sharing obligations that is counter to Ocare. Congress never appropriate the money to make the payments but that is not an excuse according to the judge.
Ohio
Counties v Four Drug comanies
The four companies agreed to pay the tow Ohio counties $60 million to settle allegations regarding their role in the opioids epidemic. This was done just before the trial was to begin.
Oklahoma
v J&J
Error
Judge Balkman screwed up. He presided over the case involving the company against the state. The ruling was the company would need to pay $572 million. Part of this was $107,683,000 to combat neonatal abstinence syndrome. He does not know how to use a calculator since this was supposed to be only $107,683.
EEOC
v Tennova
Filed
A nurse had an on he job knee injury that required surgery and recovery. Her physician placed her on permanent intermittent sedentary activity for a third of the day. The Clarksville, Tennessee hospital would not comply and fired the nurse. Since she was not offered a reasonable accommodation the EEOC is going after them.
Franciscan
Alliance v Azar
Judge
The judge voided gender identity as part of what is protected under Ocare. Sex means male female not gender according to the judge.
Trillium
Community Health Plan v Legacy Health
Filed
The plan has sued Legacy Health, Providence Health and OHSU Health for not dealing with them in the Portland, Oregon area. They want to sell insurance to the Medicaid market but state they are being frozen out by the Big Three who control the major hospitals in the area and have a competing organization to sell the same policies. Top
Patients
v Kalispell Regional Healthcare
To Be Filed
The hospital was hit with a phising scam and the information of 130,000 patients were compromised. They are NOW "taking further steps to revise procedures that will minimize the risk of a similar event from happening again".
Patients
v hunt Memorial hospital District
To Be Filed
The hospital has warned their entire data base about a cyberattack that compromised their records.
Patients v
Geisinger
To Be Filed
Geisinger Health Plan used Magellan National Imaging Associate to manage radiology benefits. An employee of Magellan had a phising attack and the account was used to send out commercial spam emails. PMI may have been compromised. Geisinger no longer uses Magellan.
Patients
v Prisma Health
To Be Filed
An employee had her log in information credentials compromised. The information at tow hospitals were potentially exposed online. The system waited months to notify patients about the problem. They admitted not knowing how long the information was exposed. This affected about 22,000 people. They state they have NOW taken steps to prevent this from happening.
Rollins
v Dignity Helath
Settlement
A judge turned down the settlement between the workers and the company due to allowing Dignity to keep any difference between the $6.15 million attorney fees agreed to and the amount actually awarded. The judge says this money should go to the class. Top
Cepeda
v Geisinger
Filed
the parents of an infant who died from Pseudomonas contracted in its NICU. The suit states the the Clinic knew of the infections in the unit and did not warn the public.
Vera
v Children's of Alabama
To Be Filed
The 4 year old was a patient in the hospital when he fell off a wagon, sustaining a head injury and dying.
Slemp
v J&J
Mo Ct app
Slemp won $110 million against the company for developing vaginal cancer supposedly from talc products. Teh appeallate court tossed the verdict relying on the state supreme court pronouncement that limited the out of state plaintiff ability to forum shop. J&J is now 4 for 4 in overturning these decisions.
Doe
v Wellspan York Hospital
To Be Filed
John Doe was in the waiting room of the hospital ED after coming by ambulance. The staff ignored him and he was found dead 3 hours later. he had complained of nausea and dizziness. The staff at triage had difficulty getting a pulse oxygen. They had called for him three times but somehow he did not respond.
Pennington-Thurman
v Christian Hospital Northeast
ED Mo
In an early stage of the case the woman cold go forward with her EMTALA claim of not stabilizing her. She came to the ED via ambulance for severe leg cramps. The MD reviewed her chart and noted the flag to call her oncologist but did not. Her lab work came back WNL and she was no long seemingly in distress so she was released. However, she refused to sign the discharge papers since she did not feel well. She vomited but was wheeled into the waiting room to be picked up. For this she sued. Let us hope she spends alot of money on this case and loses.
OIG
v Doctors Hospital Augusta
Fined
The OIG fined the hospital $180.000 for their "rapid medical screening" and denying a transfer by substituting the receiving physician's opinion over the transferring physician's opinion. The rapid screening allows the hospital to shortcut the EMTALA requirements and ask for payment upfront prior to needed tests being performed. It is always the transferring hospital's opinion regarding the transfer that is the important one. The receiving physician may make suggestions but not deny the transfer. Top
Farris
v Labette City Medical Center
D Kansas
Dr. Michael Farris was the medical director of the ED of the hospital when he says the hospital CEO Brian Williams changed one of his orders and also changed the facility to which the transfer of a patient was to occur. He reported the action to the appropriate people and was fired. He is suing for wrongful termination along with violations of EMTALA and continued staff privileges. The court ruled that the could proceed on all but the ability to stay on staff. He could get monetary damages and these could be significant.
Babb v
Geisinger Clinic
Pa Superior Ct.
Dr. Terrance Babb sued for breach of contract and won $5.5 million. The appellate court upheld the verdict. Babb apparently had a problem working with tow other employee physicians and was fired. This was in 1997. After many years of rulings and appeals a jury awarded the physician the money and the hospital appealed again. He had signed a non-compete clause that said he shall be afforded the opportunity for a review of the circumstances if he is fired, He did not get this. He had a renewable two year contract. He had been recommended for a new two year term at the time of his firing. Top
Oduyale
v California Board of Pharmacy
Ca Ap Ct
The Board revoked stayed Soloman Oduyale's pharmaceutical license with three years probation and then 10 years later the board filed an additional accusation and revoked his license. The trial court on writ of mandate ruled that the board abused its discretion for failing to analyze alternative sanctions and remanded back to the board. On appeal the court ruled to reinstate the revocation stating the board does not have to list reasons for not imposing other penalties as long as they can justify the revocation. 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.