September 15, 2021  Recent Legal News

Criminal

Fraud

Healthcare

HIPAA

Peer Review and Employment

Criminal

New York v Clifford, Barkley
Indicted

Jamine Clifford, (AntiVaxMomma on Instagram) and Nadayza Barkley have been accused of selling fake vaccination cards.  Those who have been accused of buying the fake cards work in hospitals, medical schools nring home or other essential settings.  They will also be charged.

US v Arnold
Guilty

Dr. Janet Arnold of Eastern Washington plead guilty of distributing narcotics without a legitimate medical purpose.  She pre-signed multitudes of blank narcotic forms and allowed her addict office manger to fill in the blanks.        Top

Fraud

US v Palatnik
Guilty

Leonel Palatnik of Aventura, Florida, plead guilty of paying kickbacks to another to arrange kickbacks to authorize via telemedicine genetic testing that was not needed.  

US v UPMC
Filed

The feds have filed under the False Claim Act against UPMC, along with the University of Pittsburgh Physicians and James Luketich, the chair of its Cardiac Surgery program.  The complaint says that Dr. Luketich bills for up to three complex surgical procedures being done at the same time.  One can not bill for concurrent surgeries.  This wasa qui tam case by another physician.  It should be his retirement program.

Taylor v Comhar, Inc.
Dismissed

Taylor worked for the residential treatment facilities and after seeing improprieties and being terminated filed suit for billing for worthless services.  The case was tossed, not because of the incidents, but for the lack of particularity in the filings, a rookie mistake.  She showed that the negligence may have been there but did not show the worthlessness of the care nor the harm to the patients.

US v John Peter Smith Hospital
Settlement

The Texas hospital agreed to pay over $3.3 million to settle allegations that they upcoded using modifiers that weren't indicated.  This is a qui tam by a former employee who will split almost $1 million with her attorney.

US v Saint Francis Medical Center
Settlement

The Missouri hospital agreed to pay $1.6 million to settle allegations that they did not look after their employee, Dr. Dickinson, who wrote many opioid prescriptions for no medical reason in violation of the Controlled Substance Act.

US v Connections Community Support Programs
Settlement

The Delaware based mental and treatment facilities agreed to pay $15.3 million to settle allegations that they billed for services by individuals where were not allowed to bill and not keeping proper records.  They have gone bankrupt so the actual amount paid will be much less.

US v Talbot
Indicted

Dr. Adrian Talbot of Slidell, Louisiana, was indicted for allegedly prescribing narcotics with no medical reason and conspiracy to commit health fraud.

US v At Home Care, Cox
Settlement

The Bend, Oregon, residential care company and it owner Kevin Cox have agreed to pay $2.9 million to settle allegations that they submitted false claims by billing for services not performed.

US v Bandy
Sentenced

Shelly Bandy, the co-owner of the North Carolina DME company, A Perfect Fit For You, was sentenced to 30 months in prison and ordered to pay restitution of $374,800 for filing false clams for DME for patients who did not order the equipment.  This is a criminal case.  The earlier civil case got over $20 million from the company and the other co-owner Margaret Gibson agreed to pay $4 million.    Bandy had agreed to pay over $34 million in the civil action.  The company was ordered to pay an additional $10 million in a criminal case.

US v Chinn
Arrested

Dr. Kingsley Chinn of Fort Lauderdale, Florida, was arrested on chargeds of violating the kickback laws.  He is the CEO and founder of SpineFrontier, a medical device company.  It is alleged that he and Aditya Humad, the CFO, paid surgeons sham consulting fees for work not performed.  the surgeons agreed to use SpinalFrontier products.  .  The two had a prior civil case filed by the feds against them.  Several surgeons have already plead guilty in the civil case and have paid a total of $3.3 million in penalties.

US v Portis
Guilty

Former NFL running back Clinton Portis has plead guilty to healthcare fraud.  He admitted he participated in a scheme to defraud the Gene Upshaw NFL Players Health Reimbursement Account Plan by making false claims.  

US v Midland Memorial Hospital

The hospital agreed to pay $555,141 to settle self reported billing for billing the Covid program without primary or secondary Covid

US v Bell Therapy
Settlement

The Milwaukee community support program agreed to pay $390,000 to settle allegations that they billed for services at the incorrect rates and billed for services not reimbursed.

US v Oaktree Medical Centre, FirstChoice Healthcare, Labsource Pain Management Associates of North Carolina
Settlement

All of the above North Carolina pain management clinics are owned by DC Daniel McCollum and the court entered a default judgment of $140 million.  They are accused in an qui tam case of giving illegal payments for referrals for drug urine tests.  

US v Clampa
Sentenced

Richard Clampa of Commerce, California, was sentenced to 84 months in prison.  He was the CEO of Atlantic Health Services, a substance abuse clinic, and was convicted of defrauding Medicaid by billing for services not needed.

US v BAYDA
Settlement

The New Jersey home health agency agreed to pay $17million to settle allegations that they paid kickbacks to a retirement home operator by buying two or his Arizona home health agencies.  

US v Sachs
Indicted

Carole Sachs OD was indicted for submitting false claims to Medicare for services not provided.        Top

Healthcare

Gilreath Dental Associates v Cincinnati Insurance
11th Circuit

The insurer was sued for loss of income due to Covid under their policy.  They lost as the court affirmed the dismissal of the case since they failed to allege any property damage as there was no damage or change in the property in any way that required repair or precluded its future use for dental procedures.  This is the second case against this insurer and the second win for the insurer.

Kheriaty v UC Board of Regents
Filed

Dr. Aaron Kheriaty, a psychiatry professor and ethicist at UC Irvine medical school sued his employer over a vaccine mandate.  He believes his natural immunity from his known Covid infection provides him better immunity than the vaccine and he and other in the same position should not be forced to take the vaccine.  He has scientific backing on his side but the question is whether or not an employer can make one policy for everyone.

States v Purdue Pharma
Settlement

The Bankruptcy Federal Judge has spoken.  Some do not like it but the settlement plan was accepted.  Purdue Pharma will cease to exist and be a new charity oriented company with a board appointed by public officials and the profits will go to the governments to help with drug addiction.  A compensation fund will be set up to give victims of the evil drug $3,500 to $48,000 each.  The owners, the Sackler family will pay $4.5 Billion to settle all claims and will be exempt from future civil claims.

Smith v West Chester Hospital
Reversal

The judge in this case reversed himself.  Originally, he order the hospital to give Covid patient Smith Ivermectin.  Now he had reversed that order since it has been show that the drug is not effective for Covid.  However, it has been given to the patient for 13 or the ordered 21 days and the patient is recovering and is now off the ventilator.        Top

HIPAA

Hestrup v DuPage Medical Group
Filed

Two days after the announcement by DuPage Medical that about 600,000 patient's personal information may have been compromised an attorney found two souls to begin a class action suit.  They accuse the medical group of negligence for not doing enough to protect patient's information and for not telling them quickly about the breach.  

Patients v Desert Wells Family Medicine
To Be Filed

The Arizona clinic had a ransomware attack that compromised 35,000 patients records.  The IT system has now been down since May 21 since the hacker corrupted not only the medical records system but also the backup system.  

Burka v Vanderbilt University Medical Center
Verdict

Dr. Burka sued Vanderbilt to defend him in a lawsuit accusing him that he snooped into his ex-wife's medical records.  The hospital argued that the  action violated the terms of the employment.  The court ruled for the university on all counts.       Top 

Peer Review and Employment

Leadbitter v St. Clair Hospital
Pennsylvania Supreme Court

The high court overturned a lower court decision that would have allowed a hospital to turn over in a med mal case peer review documents.  The plaintiff had post op complications and claimed that the the hospital's credentialing was inadequate and they should have known that the physician lacked expertisse in the procedure performed.  They wanted the documents the hospital's credentialing committee reviewed when the doctor applied for privileges.  The trial court erroneously ruled that that files relating to a a physician's membership are not protected and since information requested by the hospital from the NPDB was part of that it was also not protected.  This was affirmed by the appellate court.  The high court said a committee that does peer review even if not called a peer review committee has protected status and NPDB files can only be by regulation used for the purposes for which the NPDB provided it.

Hartsuch v Ascension Medical Group
WD Wisc

Dr. David Hartsuch was a locum physician at Howard Young Medical Center in Wisconsin.  He was concerned about the Covid protections used by the hospital.  He spoke to the medical director about this and followed up with multiple emails.  The director became worried that if he did nd not accede to Hartsuch's demand he would not show up for his clinics.  The director then stopped scheduling Hartsuch and Hartsuch sued for interference with business.  The court ruled for the hospital since Hartsuch did not meet his burden to show he was fulfilling a specific legal mandate nor was Ascension conduct even if interference improper.        Top

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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.