October 1, 2015 Recent Legal News






Peer Review and Employment


Farnsworth v HCA
MD Fla

A former employee sued the system for Medicare fraud and retaliation .  The court allowed a motion to dismiss for some of but all of the complaints.  She alleged that the hospital routinely billed for the treatment of patients when done by residents and no attending was present.  She also alleged the hospital falsified medical records for procedures done by a suspended physician.  She also said the hospital encouraged its staff to lie on reports to bill for unnecessary procedures.  She lastly said that she was fired after reporting the fraud to management.  The court allowed dismissal of all claims where a third party did the billing.All claims against it directly were allowed.

California v Uwaydah

The LA DA has filed charges of fraud against Dr. Munir Uwaydah and others for surgeries done on patients by non physicians leaving them with unnecessary scars and some needing additional corrective surgery.  He had lost his license in 2013 from a case in 2009.  Part of the charges were against his attorney and others for other bad things.  Uwaydah was arrested in Germany and awaits extradition.  He is not licensed in California.

US v North Broward Hospital District

Finally, years after they refused to listen to their own attorneys and fired them, the District is settling this case.  They are paying $69.5 million and it probably should be more.  The poorly run hospital district gave huge amounts of money to several physicians who were employed.  The case was from a whistleblower Dr. Michael Reilly who will receive over $12 million for his work.

US v St. John
5th Circuit

The appellate court said the lower court did not err when they convicted and sentenced Lawrence St. John and his son Jeffery for falsely certifying patients were homebound so they could do house calls.  They ran a certifying business.  The dad was ordered to pay $9.6 million and the son $8.6 million.  That should deplete their ability to pay their attorneys.

US v  Polukhin

Dr. Elena Lev Polukhin of Bloomington, Minnesota, has been indicted for illegal kickbacks and fraud.  She is alleged to set up a chartable non profit and received money for referring patients to a single pharmacy for pain meds.  She also alleged to at least once write a prescription for narcotics without medical justification.

US v Cain

The feds have intervened in a case where Stone County Hospital in Mississippi along with the owners of the hospital were sued on a qui tam basis.  The suit states the that the defendants did no work for their payments and charged cars to the hospital illegally.

US v Adventist Health

The system agreed to pay $115 million to settle claims they had improper physician payments and also miscoded claims.  The employed physicians were paid bonuses based on a formula that took into account the value of the physicians' referrals to the hospitals.  Illegal has hell.  There were two whistleblowers in this case.  

Physicians v Mesa Medical Group
6th Circuit

The court called the organization thieves but refused to hold them liable for their theft.  The group hired independent contractor physicians and nurses to work in the EDs.  They found that the people were really employees and as such needed to have withholding.  They docked the pay of the employees and used the money to pay IRS.  The scumbags now are making their employees go after the IRS for refunds on the money they took.  All working for them should quit and go to a competitor.  

Mountain View Surgical v CIGNA
Ca Ct App

In a good example of how not to sue the surgical center did $1.16 million in services to 41 Cigna patients.  Cigna did not pay and accused the center of fraud for release of patients from their co pays.  The center sued and had many claims tossed.  They then refiled and had many more tossed including not pleasing with specificity in 28 of the 41 cases.  They can now sue for fraud on only 13 cases and will now spend more than they recoup on the case.

US v Schneider

Dr. Stephen Schneider and his wife Linda of Haysville, Kansas, were resentenced to 30 years and 33 years respectively.  They had been convicted of fraud, money laundering and unlawful distribution of controlled substances.

US v Kressein

Elizabeth Kressin, DC from Spencer, Iowa, agreed to pay $62,349 to settle accusations that she did and billed for treatments that are not allowed under law.  These included bed wetting.  Draw your own conclusions as to her competency.    

US v Persad

Dr. Harold Persaud a cardiologist of Westlake, Ohio, was convicted of fraud.  He billed for more more expensive procedures than those performed and falsified stress tests to justify unnecessary heart caths.  


The system is paying a fine of $15.8 million for settlement of overusing implantable  defibrillators.  The Medicare rules on this are archaic and need to be changed.  They say one can not implant until after 40 days post MI or 90 days post CABG.  This is part of a national probe by the feds.  

US v St. Francis Hospital

 The Delaware hospital had a person working in its inpatient rehab unit that was excluded from participating in fed med.  They billed illegally and now must repay $4 million to settle.

 US v Gross

Dr. Robert Gross a psychiatrist in San Angelo, Texas, pled guilty to fraud.  He submitted bills for services not rendered in the manner billed.  This included billing for visits with dead people.  He has agreed to pay $1.8 million in restitution.  He will be sentenced later.

US v Pon

Dr. David Pon of Windemere, Florida, was found guilty by a jury of 20 counts of fraud.  He intentionally misdiagnosed about 500 Medicare folk with wet macular degeneration to do unnecessary testing and treatments.         Top


Patients v Sutter Health
To Be Filed

A Sutter employee emailed to himself electronic versions of billing documents which had the info on over 2500 patients.  The breach happened in April, 2013. 

Patients v Bayard
To Be Filed

 Dr. Max Bayard of St. Albans, Vermont, had an office break in where the thieves stole devices with patient information.  It is unknown whether or not the information was encrypted.  Over 2000 people have been affected.

Patients v Systema Software
To Be Filed

Systema Software that does insurance claims data dumped about 1.5 million records onto Amazon Web Based Services.  It was found by a techie who was looking for things like this.  This was a contractor mistake.

Patients v Oakland Family Services
To Be Filed

The nonprofit in Pontiac, Michigan, was phished and 173 accounts were compromised in 23 minutes.  They stopped the attack within 15 minutes, a great feat.

Hunter, Borbley, Gambino v George Washington Hospital

Two class action suits were filed.  One against George Washington University Hospital and the other against Medstar Georgetown University University Hospital.  both are for being overcharged for access to electronic medical records.  The third party contractor for Medstar, Healthport, sent a bill for $22.88 per page an shipping handling fee of $16.38 per page.  Gouging at its finest.  

US v Borrengo

Blanca Borrengo, an illegal, stole an identity and went for an annual GYN exam at the Northeast Women's Healthcare Clinic in Atascocita, Texas.  She was arrested at the clinic after the Sheriff was called by the staff.  The idiot attorney does not disagree with the arrest but was concerned the authorities were called for the identity theft.  Healthcare is a right according to the idiot attorney.  She thinks it is a violation of HIPAA.  If so let her sue the clinic.

Patients v Premera

To date, there have been 38 class action lawsuits filed against the Washington system.  So far only a small percentage of the 11 million patients affected by the security breach have applied for credit protection.  Some people have already been compromised by false tax returns or other identity theft.        Top


Baugher v Kadlec Health
ED Wash

The patient sued the hospital for EMTALA and med mal after she went for an medical condition to the ER and was either asked to leave or left on her own.  In view of the lack of evidence by the hospital it is assumed the former.  The issue of damages would be decided by a jury and even though there is no physical injury it is reasonable that emotional damages occurred.

Rios v Hospital HIMA San Pablo Fajardo

In another case from the island a patient died after being discharged from a hospital emergency room.  The family sued and lost the EMTALA claim since only a case brought on behalf of the deceased can be heard.  The relatives themselves had no direct claim.  One would think the attorney would know that.        Top


Heartland Christian College v US
8th Circuit

In a huge reversal for Obamacare's contraception rules the court ruled that the burden of complying with the law would be huge for the college and CNS International Ministries, the other plaintiff in the case.  This will force the Supreme Court to take the case and make another ruling similar to Hobby Lobby, as there is now a disagreement among the Circuits.        Top


Prime Healthcare v Harris

Prime Healthcare is suing California Attorney General Kamela Harris for abusing her power.  The now democratic candidate for US Senate was apparently promised $25 million for her campaign if she ruled for the SEIU against Prime in their bid to take over the Daughters of Charity hospitals.  Daughters told Prime it needed to make a deal with the union for Harris' blessing.  The spokesperson did not address the charges but blasted Prime, typical political speak.  This lawsuit should be interesting in the upcoming primary and if needed general election.

Chinese Hospital v Chinese Community Health Care Association

The SF Business Times reports the hospital countersued the association for money they say is owed to HHS.  This comes one month after the hospital was sued by the IPA for breach of contract and unfair business practices.  The 30 year partnership is now dead.  This does not bode well for the hospital when it loses its referring physicians.

US v Massachusetts General Hospital

The hospital agreed to pay the feds a whopping $2.3 million to settle the allegations of its lax oversight of the drug supply allowed two employees to pilfer thousands of pain pills.  Bad hospital.    

Amos v Oregon Hospital 

Claire Amos was admitted to OHSU Hospital for one week.  She was billed $31,000 so is suing because the hospital would have billed insurance companies much less. She claims the hospital did not tell her and other uninsured emergency room patients about billing them at a higher rate.  Class action has been asked for.  What the suit does not say is why she went to the hospital and that the hospital probably bills the same to the insurance companies but accepts less due to a negotiated rate.         Top

Peer Review and Employment

Boly v Legacy Good Samaritan Medical Center
Jury Trial

Nurse Linda Boly won big money on her wrongful termination suit in Oregon.  She won $96,000 in lost wages, $625,000 for emotional distress and $1.5 million in punitive damages plus payment of about $500,000 in attorney fees.  The nurse complained that their cost cutting measures were harming patient care.  They reduced their workforce by about 400 and were paying their managers bonuses for staying within budget.  Boly was the highest paid nurse when the managers were trying to reduce payroll.  Boly was then written up three times for not meeting productivity quotas and working after shift.  The jury did not believe the hospital.

Hsu v Prime Healthcare
Ca Ct App

The physician was the medical director of Prime's hospital A but joined the law suit against Prime hospital B for their admitting patients instead of placing them on observation status.  He was then fired as medical director of his hospital and sued as a whistleblower.  The hospital pled for arbitration as his contract said any dispute regarding non-professional issues were to be settled by arbitration.  The trial court and the appellate court both said this was related to professional practice and therefore can be settled in court.

Tate v State of Nevada Medical Board
Nevada Supreme Court

The ongoing saga should now be over for a while.  Tate showed up for surgery after having one drink for lunch.  He was reprimanded by his employer and reported to the Board.  The Board went nuts and suspended his license for six months as well as other onerous stuff.  He filed a petition to stay the reporting to the data bank while he appeals.  The trial court refused to issue the stay and he appealed.  The high court agreed with the physician saying he could be irreparably harmed if reported prior to the appeal.        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.