US v Arnold
Dr. Janet Arnold of Benton City, Washington was sentenced to 48 months in prison for possession and distribution of narcotics. She hired several addicts to work in her office and proved them blank prescription blanks along with fake patient names to be used in filling the prescriptions.
US v 12 Medical Professionals
The feds indicted the following : Eskender Getachew, MD of Columbus, Ohio, for unlawful distribution; Charles Kistler,DO of Upper Arlington, Ohio, for unlawful distribution and unlawful prescribing; Yogeshwar Gil MBBS of Manchester, Tennessee for distribution; Contessa Holley, RN of Pulaski, Tennessee, for possession with intent to distribute along with wire fraud; Francene Gayle MD of Orlando, Florida, unlawful distribution; Robert Taffet MD of Haddonfield, New Jersey, distribution; Hau La MD of Brentwood, Tennessee unlawful distribution; Frederick De Mesa fake MD and illegal distribution: Loey Kousa MD from Paintsville, Kentucky, unlawful distribution and Jay Sadrinia DMD of Villa Hills, Kentucky, illegal distribution.
Missouri v Hall
Jennifer Hall was charged with murder in a case from 2002. She is accused of giving Fern Franco Succinylcholine and morphine while she was a respiratory therapist at Hedrick Medical Center in Chillicothe, Missouri. During her employment there was an large increase in cardiac emergencies which abated when she was let go. Prior to her employment at Hedrick she was convicted of arson at Cass Medical Center. that conviction was overturned due to ineffective counsel and the she was later acquitted.
US v Berkowitz
Dr. Andrew Berkowitz of Huntington Valley, Pennsylvania, was sentenced to 20 years in prison. He had earlier been convicted of running a pill mill as well as fraud for billing for unnecessary procedures and for treatments never provided. He was also ordered to pay $40,000 fine and almost $4 million in restitution. Tacked on is an additional $1.8 million for false claims.
Tennessee v Vaught
RaDonda Vaught, RN was sentenced to three years probation for the reckless homicide of a patient. She made a medical error but was convicted in the criminal justice system for it. This miscarriage of justice was somewhat remedied by the light sentince imposed by the judge.
US v PillPack, LLC
The Amazon subsidiary agreed to pay $5,79 million to settle allegations that they over billed for insulin by underreporting days of supply of insulin dispensed.
US v Malviya
Dr. Vinay Malviya and his medical corporation of Bloomfield Hills, Michigan, agreed to be excluded from fed med for three years as part of his settlement for billing for radical hysterectomies when only simple ones were necessary and upcoding or billing for services not rendered.
US v Lee
Dr. Donald Lee of California was sentenced to 93 months in prison for reusing single use catheters on patients and billing for new catheters. He also did unnecessary medical procedures and then upcoding. He was also ordered to pay 4.5 million in restitution.
US v O'Lear
Thomas O'Lear of North Canton, Ohio, was convicted by a jury of fraud. He was president of Portable Radiology Services and billed for services not performed.
US v Sabet
Robert Sabet of New York plead guilty of health care fraud. He owned two New York pharmacies and billed fed med for meds that were not needed or were provided with kickbacks and bribes.
US v Ruffai
Dr. Elemer Raffai of Rome, New York, was indicted for using telemedicine to sign prescriptions for DME that were not needed.
US v Luke, Laughton
Stephen Luke and David Laughlin of Phoenix owned RediDoc, a telemedicine company. they are accused of submitting false claims to Medicare and Tricare by giving false names to physicians to prescribe DME.
Los Angeles v Sameday Health
The consulting company was accused of billing up to $450 for a several minute consultations with patients regarding Covid. They are also accused of falsifying lab reports for Covid tests.
US v 10 Defendants
A Miami federal judge sentenced 10 people who had been convicted of fraud regarding PT clinics that recruited and paid kickbacks to beneficiaries of Blue Cross and submitted claims for service never performed. They are: Jorge Perez, owner of a PT clinic sentenced to 120 months and ordered to repay $4,143,892; Orlado Leiva MD to 57 months and ordered to pay $2,867,770; David Sacerio, PT owner to 51 months and pay $686,086; Kiamy Perez PT owner to 34 months and pay $686,086; Enry Guman patient recruiter sentenced to 33 months and to pay 228,075; Kyenia Rodriguez PT assistant sentenced to 30 months and ordered to pay $686,086; Freymil Lozada patient recruiter sentenced to 27 months and order to pay $184,373; and Haniel Rodriguez patient recruiter sentenced to 24 months and ordered to pay $190,540. Two others Brian McIntosh a patient recruiter and Melissa Cruz a office employee were ordered to pay $119,174 and $ 686,086 respectively.
US v Hearns, Egans, St. Julian
A federal jury convicted the trio of submitting claims for Atlantic Recovery services, a substance abuse treatment service for middle and high school students. The bills submitted were for students that did not need the services. The three convicted are Gregory Hearns of Compton, California, a billing supervisor; LaLonnie Egans of Bellflower a former manager and Tina St. Julian of Inglewood a counselor.
US v Prism Behavioral Solutioins
The San diego firm paid $650,000 to settle allegations that they billed Medicaid for service for autistic children but never provided the services.
Massachusetts v Integrity Home
The Tewksbury home health agency agreed to pay $550,000 to settle allegations that they billed for services not properly authorized by a physicians.
US v SHC Home Health Services of Florida
US v Buford
Edward Buford DDS of Silver springs, Maryland, plead guilty to fraud billing for dental services proved by a person not approved. He also paid kickbacks for patients.
United HealthCare Services v TeamHealth
The court refused to dismiss the charges made by United against Team Health for fraud and violations of RICO.
Espinoza v Chacon
Espinoza died during surgery and the suit included the usual plus fraud, misrepresentation and battery. Later plaintiffs attempted to add punis. The defendants said it was too late but the trial court said it was OK. The appellate court overturned stating the other claims all came from the med mal claim and therefore the statute held.
Johnson v Cedars-Sinai Hospital
The wife of Johnson died about 12hours post partum c-section. The suit says that there were signs she was bleeding internally after the surgery but was not returned to the OR until it was too late. He says the real cause of death is that they are black.
McQuillen v Borno, Lubbock Heart
Plaintiff had a pacemaker placed by Dr. Borno at Lubbock Heart Hospital. There were complications and she required several more procedures. One year later the device showed no usage and after several consults she was told she had a condition that never required a pacemaker. She sued all for negligence and vicarious liability against the hospital. The trial court dismissed the claims against the hospital due to the plaintiff's expert never mentioned the hospital. The appellate court said since the hospital never objected to the amended report it waived any objections to the report. It also said that if a claim involves a vicarious liability theory an expert report that implicates the actions of the parities employees is sufficient to implicate the party.
Nulph v Houston Healthcare System
Dr. Nulph was the ER director at Perry Hospital. After the hospital said all patients without an ongoing relationship with one of their physicians should be transferred Dr. Nulph said this violate EMTALA and reported them to to HHS. He was terminated from his leadership position and then sued for retaliation. The court ruled on a motion by the hospital that the hospital was wrong in all its motions and that the case against the hospital could go forward.
Allgood v Baptist Memorial Health
Margaret Allgood was a NP at the hospital who witnessed fraud and was asked to perform fraudulent acts by the hospital. After reporting fraud she was suspended with pay for four months and is now suing for retaliation. The hospital accused her of violations of HIPAA. The court ruled the case should proceed.
Gomez III v Memorial City Hospital
Dr. Gomez is a CV surgeon who started and promoted off pump robotic heart surgeries at the hospital. Methodist West Hospital began recruiting Gomez and Methodist started a whisper campaign against Gomez. He was hired by Methodist and sued Memorial for tortuous interference, defamation and disparagement. The jury agreed and he won $6.3 million and the appellate court also agreed. The Supreme Court reversed saying defamation requires proof of publication of the false statement of fact to a third party. The telling of lies about Gomez to Methodist did not cause harm as he was hired.
Keller v New York-Presbyterian/Columbia University Irving Medical Center
Dr. Deborah Keller, an attending colorectal surgeon at the hospital filed suit against the institution for gender discrimination. She alleges pay discrepancy, retaliation. This is not an uncommon scenario in the large hospital settings as gender discrimination is frequent. She did not have her contract renewed and after some considerable looking process she is now at UC Davis.
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.