US v Primero
Camilo Primero and Aurora Beltran of the Glendora, California, area were indicted for health fraud. Primero, a former physician, and Beltran allegedly filed false Medicare documents to allow Primero to operate hospice and home care agencies.
US v Brown
Dr. Nathaniel Brown of Cleveland, Mississippi, was sentenced to 39 months in jail along with a repay of $1,941,254 for referring patients who were not hospice appropriate.
US v Gray
Dr. Yev Gray, DPM, of Chicago, was sentenced to 90 months in prison and ordered to pay $6,974,895. He owned Aggeus Healthcare which did podiatry at long term care facilities in multiple states. He made an EMR with made up diagnoses. His wife, an attorney, is also in jail for one year for her part in the fraud.
US v Florida Cancer Specialists
and Research and 21st Century Oncology
The two cancer groups have been accused of antitrust for splitting treatment services in Florida. This is a whistleblower suit which includes a gender discrimination claim against Florida Cancer. The suit was filed by a prior HR person and a CFO. 21st Century is in bankruptcy and has settled federal investigation of fraud.
US v Mylan
Mylan has agreed to pay $465 million to the feds for over billing Medicaid to EpiPen. This started from a suit by Sanofi who will get $37 million of the settlement.
New Mexico v Lovelace
Lovelace was sued by a whistleblower in 2010 and after an investigation that lasted five years the state finally went after Lovelace as well as its parent Ardent Health and a former parent Cigna. The state claimed that the consortium did not pay over $142 million in owed taxes. However, as politics go, New Mexico's Attorney General collected from Lovelace and Ardent about $2.5 million and $45,000 from Cigna. As part of the settlement the state agreed to keep the deal secret but that didn't happen.
US v Sightpath Medical
The company paid $12 million to the feds to settle allegation that it gave illegal kickbacks to physicians for their business. The whistleblower case said the company paid consulting fees for services never rendered. The settlement also involved the former CEO who they state was directly involved in the fraud.
US v Skaff
The Charleston dentist Antoine Skaff, plead guilty to fraud and agreed to pay $2.2 million to Medicaid, three times their loss. He will also need to pay for criminal charges in a fine of $738,000 and faces up to 10 years in jail. He upcoded especially for impacted wisdom teeth.
US v St. Agnes Healthcare
The organization agreed to pay $123,000 to resolve allegations that it billed for higher EM claims than allowed. This after it purchased 12 cardiologists and started billing for them. They billed the patients as if they were new. This is a whistleblower suit by a former cardiologist of the organization. This is a very dumb hospital billing department.
US v US Bioservices Co.
The company agreed to pay $13.4 million to settle allegations that it acted with Novaritis with a kickback scheme. They were promised more referrals for refilling more prescriptions for Exjade. The money is mostly repayment but there is also money to resolve fraud claims.
Vermont v Gruber
Professor Jonathan Gruber, yep that Gruber, the architect of Ocare, agreed to pay $90,000 to resolve allegations that is submitted false invoices to the state. He is also the one who said that Ocare only passed because of the stupidity of the American people. He was right about that.
Neuron Shield v Medical Practice
In a question of who is greedier Neuron, a group of physicians who monitor the status of patients nerve system during surgery, is suing their billing company. Why? Because the did not bring in enough money. Of course the physicians are billing for a huge amount of cases and how many are really necessary to have been monitored. This is happening in Texas, of course.
US v Daugherty
David Daugherty of Myrtle Beach, South Carolina, is a retired social security administrative law judge. He has been sentenced to four years in prison for his part in getting federal disability payments illegally to claimants. He also must pay $93 million in restitution. He was in cahoots with an attorney and told the attorney which cases he was going to hear and what evidence to bring. The attorney Eric Conn then paid Daugherty a kickback of $8000 per month. Conn is a fugitive and was sentenced in absentia.
US v Laird
Dr. Gordon Laird agreed to pay $580,000 to settle allegations that he filed false claims for procedures he did not do nor supervise.
US v Kirkwood
Dr. David Kirkwood and his wife Beverly of Dayton both plead guilty of unlawful drug trafficking. They ran a pill mill with David seeing up to 100 patients a day for $100 per visit. He has also agreed to pay restitution to the feds for $160,000. Top
AHA v Burwell
The DC appellate court overturned a prior decision that ordered HHS to reduce its Medicare appeals backlog. The feds appealed stating this was an impossible order. The appellate court agreed with the feds. They ordered the lower court to determine the feasibility of the order, which the district court refused to do originally.
Prime Health v California
A federal judge has dismissed the case by Prime against the state attorney general for her imposing discriminatory demands on them in the proposed purchase of a hospital corporation. The judge accurately said that Prime was attempting to make a federal case out of a state case.
Three Women v Arkansas
Three women sued the state for the right to see any medical practitioner they want after the state put in a law cutting Medicaid to Planned Parenthood. The lower court agreed with the women but the Circuit overturned that decision. The appellate court stated the Medicaid law did not create a federal right for individuals to pursue a suit. Top
Vietnam Veterans of America v US
The group was not happy when the Defense Department website Servicemember Civil Relief Act is allowing anyone to browse the site which has the private information about the military service of millions of vets. The organization wants this info private and only to be seen by financial institutions or the like.
Doe v Aetna
A Pennsylvania male is suing Aetna after his sister learned he was taking HIV meds. The company used large windowed envelopes to send information and in this case told him where to get the meds. They are looking to make this a class action case and a major payday. Top
Rush University Medical Center v
Rush as filed suit against Draeger after spending $18 million to install their patient monitoring equipment in the hospital. The system had problems and did not work properly. It sent out false alarms which led to alarm fatigue and did not do apnea monitoring reliably.
Indiana University Hospital v
The hospital has sent a letter to Indiana's Delaware County Sheriff Ray Dudley requesting payment for the hospitalization of an arrestee to the tune of $1.8 million. His entire yearly budget for prisoner medical care is only $500,000. There is also the small matter of the patient was no longer an inmate after the second day of hospitalization. The county also wonders about some of the hospital charges in the acknowledged first tow days of hospitalization for sepsis. They include getting 241 pills these first 48 hours.
NorthBay Healthcare v Kaiser
The northern California hospital group is suing Kaiser for non-payment for care received by its members in the hospital's ED. They also claim antitrust so have filed in federal court. There used to be an agreement where Kaiser would pay a contracted rate to the hospitals to see their patients but that contract expired in 2016. The hospitals claim Kaiser has underpaid them since by over $21 million. Top
Echeverria v J&J
Eva Echeverria is dying of cervical cancer. She blamed the cancer on J&J's baby talc which she used for feminine hygiene for many years. She sued and won in Los Angeles a total of $417 million. Several earlier trials were split some won by the atient and some by the company. Those lost by the company paid out $55 million, $72 million and $110 million. This case will be appealed and hopefully won by the company. The evidence for the cause and effect is weak at best.
Bullington v MC Precise
The hospital attorneys tried to pull a fast one and got caught. They had a tolling agreement with the plaintiff and then tried to defend the case on the statute of repose. Glad they got caught and hope they had to pay costs. Top
Zamanian v Jefferson Parish
Dr. Bahram Zamanian sued after he lost his privileges at the hospital for the usual claims and breach of contract. The court said he properly claimed due process and a protected property interest but he lost his federal claims based on having a fair process during the hearings. The court is allowing the contract claim to go forward since the hospital is defending on HCQIA grounds and the plaintiff needs more time for discovery. He will eventually lose this as well.
Persaud v St. John Medical Center
Dr. Persaud is suing the hospital for terminating his privileges and also for defamation for sending out letters to his patient that they had unnecessary surgery. The cardiologist filed a suit against the hospital and other physicians several years ago but then dismissed it with prejudice. He now files basically the same case and expects a different result. It should be mentioned that he is representing himself and is currently in the federal prison for medical fraud. He was convicted of doing unnecessary procedures and billing Medicare for them. This cas got no where, just where it should go. 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.