In 2012, Marion Healthcare, an outpatient surgery center in southern Illinois, commenced an antitrust action against Southern Illinois Healthcare (“SIH”), a multi-hospital system operating in the same market. Marion alleged that SIH had negotiated exclusive dealing relationships with several area health insurers, and that these agreements made it difficult, if not impossible, for Marion to compete for surgical patients in … Continue Reading
Category Archives: Healthcare Litigation
Subscribe to Healthcare Litigation RSS FeedNew Consequences for Unpaid Medicare Overpayments
For years, CMS has had the authority to refuse to enroll new Medicare providers if they or their owners have an unpaid Medicare overpayment, but CMS was not exercising this authority. Now, it appears that CMS is going to start. In January, CMS published Transmittal 1998 announcing that it intends to begin denying provider enrollment applications, or change-of-ownership applications, where … Continue Reading
Has the DOJ Signaled a More Critical Approach to FCA Cases?
Defendants have faced an ever increasing number of qui tam actions, yet the government has historically declined to seek dismissal of those actions where it declined to intervene. On January 10, 2018, the Director of the DOJ Civil Division Commercial Litigation Branch’s Fraud Section issued a memorandum to all DOJ attorneys, including AUSAs, advising them that when declining to intervene … Continue Reading
Florida Federal Court: Escobar Requires Reversal of $348 Million False Claims Act Jury Verdict
The United States District Court for the Middle District of Florida vacated a large jury verdict in a False Claims Act case against the owners and operators of nursing homes because the evidence did not satisfy the materiality standards articulated in the U.S Supreme Court’s 2016 opinion in Universal Health Services v. Escobar.
The court’s thorough and well-written opinion … Continue Reading
AHCA Sees the Light on Nursing Home Generator Rule, Unplugging Challenge
After Hurricane Irma made landfall in Florida, a nursing home in South Florida lost power, and several residents of that nursing home died allegedly as the result of increased temperatures caused by the loss of air conditioning. In the immediate aftermath of this tragic accident, the Agency for Health Care Administration (AHCA) (for nursing homes) and the Department of Elder … Continue Reading
Florida Supreme Court: Referral Sources Can Be Protected By A Non-Compete
Big news for home health agencies and others whose business comes from referral sources: the Florida Supreme Court just held that referral sources are the kind of protectable business interest that will support a non-compete agreement. Home health agencies, like other health care businesses, routinely use non-compete agreements to prevent marketing employees from leaving and going to work for direct … Continue Reading
The Treating Physician: Entitled to Expert Witness Fees at Trial?
When is a treating physician considered an expert witness and therefore entitled to expert witness fees when he testifies at trial? Apparently, the Florida District Courts of Appeal have formulated the typical lawyer response – it depends!… Continue Reading
“Sometimes Wrong, Never in Doubt” – A New Perspective?
Two recent studies of medical malpractice claims highlight how patient complaints may identify those surgeons at greater risk for complications, a significant decrease in paid medical malpractice claims since 1992, and the need for greater understanding of the causes of differences in claims experience across medical specialties.… Continue Reading
Requiring A Flu Shot Over Religious Objections: Risky Business
It’s flu season and many employers, particularly those in healthcare, want to require employees to be vaccinated to minimize the spread of illness. But what happens when an employee refuses on religious grounds?… Continue Reading
When a Discount May be a Kickback
Healthcare providers of all kinds, as well as medical equipment suppliers, have traditionally relied upon discounts as a legitimate means of attracting patients and commercial clients without running afoul of the federal anti-kickback statute (AKS). Congress specifically created the discount “safe harbor” to the AKS years ago based on its policy of encouraging discounts that are properly disclosed as a … Continue Reading
Former Home Health Agency Owner Sentenced to 20 Years for $57MM Medicare Fraud
The US Department of Justice announced that Khaled Elbeblaswy, the former owner and manager three Miami-area home health agencies, was sentenced to 20 years in prison and ordered to pay $36.4 million in restitution for his role in a $57 million Medicare fraud scheme.… Continue Reading
11th Circuit Awards Humana Double Damages Under Medicare Secondary Payer Act
Humana Medical Plan, Inc. v. Western Heritage Insurance Co., case number 15-11436.
Liability insurers beware, as the 11th Circuit held that Medicare Advantage Organizations (MAO) are entitled to the same rights Medicare itself would have in actions against primary payers for reimbursement of conditional healthcare treatment costs. … Continue Reading
Federal Court finds “Systemic Failure” in Processing of Administrative Appeals for Medicare Reimbursement Claims
A win for efficiency: The AHA suit may force shorter adjudication times for Medicare administrative appeals. In 2014, the American Hospital Association (AHA), along with three hospital systems, filed suit against the U.S. Department of Health and Human services, alleging that the lengthy adjudication time for administrative appeals of Medicare claim denials caused severe economic harm. See, American Hospital … Continue Reading
Identifying Overpayments Under the ACA’s 60-Day Rule Creates Additional Uncertainty in Determining False Claims Act Liability
Under the Affordable Care Act (ACA), healthcare providers that receive an overpayment from Medicare or Medicaid are required to report and return the overpayment to the government within 60 days after the date on which the overpayment was identified (commonly referred to as the “60-day rule”). An overpayment retained after 60 days constitutes an “obligation” for purposes of potential False … Continue Reading
Culture of Safety Wins: Federal Patient Safety Law Preempts Amendment 7
Florida’s First District Court of Appeal issued its opinion in the highly watched case of Southern Baptist Hospital of Florida, Inc. v. Charles et al. The First District Court ruled that the federal Patient Safety and Quality Improvement Act of 2005 (PSQIA):
- Expressly preempts any broad discovery rights afforded under Florida’s Amendment 7 for documents meeting the definition of Patient
Can We Talk? Florida Court Rejects Latest Challenge to Med Mal Presuit Authorization Law
In the latest challenge to a Florida law designed to promote early settlement of meritorious medical malpractice claims, the Florida First District Court of Appeal recently rejected a plaintiff’s arguments that 2013 amendments to the law violated the Florida Constitution. See Weaver v. Myers, Case No. 1D14-3178 (Fla. 1st DCA July 21, 2015). The court also summarily rejected the … Continue Reading
Religious Freedom and the Affordable Care Act
The fascinating interplay that weaves between the First and Fifth Amendments to the U.S. Constitution, the Religious Freedom Restoration Act (RFRA) and the Patient Protection and Affordable Care Act (ACA) continues to march on in various jurisdictions around the country, with two recent examples being the United States Supreme Court’s grant of certiorari and remand of a Seventh Circuit case, … Continue Reading
Physicians and Photography Don’t Mix
A gynecologist who secretly photographed and videotaped women’s bodies in the examining room will cost one of the world’s leading medical institutions $190 million. In a damaging blow to its reputation, Johns Hopkins Hospital has agreed to a settlement with more than 8,000 patients of Dr. Nikita Levy, who wore a pen-like camera around his neck to secretly record videos … Continue Reading
Coming Fall 2014: HHS Launches Permanent Audit Program
Beginning in the Fall of 2014, a substantial number of covered entities and business associates will receive a notification and data request from the Health and Human Services’ (HHS) Office for Civil Rights (OCR). According to Rachel Seeger, an OCR spokeswoman, “we hope to audit 350 covered entities and 50 business associates in this first go-around…Selected entities will receive notification … Continue Reading
Apologizing for Medical Injuries…Is it Protected?
Under Florida law a person may make an apology to someone injured in an “accident” or to their family without the apology being admissible in court. Thirty-eight other states have similar laws which are generally referred to as “apology laws.” Studies suggest that apologizing may reduce the risk of a healthcare provider being sued, and there is some evidence to … Continue Reading
Hospitals & Medical Staff Take Notice: HCQIA Immunity is Not Given, it’s Earned.
The Healthcare Quality Improvement Act of 1986 (“HCQIA”) is a federal law enacted to establish a national tracking system of healthcare practitioners with a history of medical malpractice payments or adverse actions. A significant provision of the law provides immunity from civil money damages for those who participate in hospital peer review process, including members of the medical staff. In … Continue Reading
Audit Log Discovery as a Feature of the Electronic Medical Record
The increased use of electronic medical records (“EMR”) is changing not only the way physicians practice medicine but also the way discovery is conducted in medical malpractice lawsuits. Plaintiffs’ attorneys seek to discover not only the contents of the medical records created by defendant healthcare providers, but also seek audit logs and access reports which are related to the EMR.… Continue Reading
Florida’s New Med-Mal Law is Pre-empted by HIPAA and is Voided by Federal Judge
A new part of Florida’s medical malpractice law has been voided by a federal judge on the grounds that it is pre-empted by HIPAA. The law, passed during the 2013 legislative session and effective only on July 1 2013, requires, as a pre-condition to filing a malpractice claim, an aggrieved patient to sign an authorization that allows the potential defendant … Continue Reading
U.S. Supreme Court tells Hospitals to Say: “Sorry Officer, I need a warrant to draw that patient’s blood.”
On April 17, 2013, the U.S. Supreme Court in Missouri v. McNeely ruled that in drunk-driving investigations where Law Enforcement Officers (“LEOs”) can reasonably obtain a warrant before a blood sample can be drawn, the Fourth Amendment mandates they do so.
A. The Fourth Amendment Protects Against Unreasonable Searches and Seizures
The Fourth Amendment to the U.S. Constitution states it … Continue Reading
