20 Recent Lawsuits and Settlements Involving Hospitals

The following hospital lawsuits, settlements or legal developments were reported within the past month, beginning with the most recent.

1. Highmark Wants Restraining Order to Keep West Penn From Other Suitors
Less than a week after their nixed payor-provider merger in Pittsburgh, Highmark filed suit for a temporary restraining order that would prevent West Penn Allegheny Health System from beginning affiliation or acquisition talks with other organizations.

2. Wyoming Medical Center Agrees to $2.7M Settlement for Alleged Medicare Fraud
Wyoming Medical Center in Casper has agreed to pay $2.7 million to settle Medicare fraud allegations stemming from a 2007 whistleblower suit, which claimed WMC submitted reimbursement requests that were inconsistent with patients' treatment records, changed the admission status of patients from outpatient to inpatient status without a physician order and billed Medicare for unnecessary admissions.    

3. Kaleida Health in New York Pays $1.6M to Resolve Medicaid Overbilling
Buffalo, N.Y.-based Kaleida Health agreed to pay $1.6 million after a state attorney general investigation revealed the system overbilled Medicaid for dental clinic services for which reimbursement was not authorized. The overbilling, which resulted in excess payments of $1.6 million, took place from January 2005 through June 2012 and pertained to dental services at Buffalo Women's & Children's Hospital Dental Clinic.

4. Former CEO of Hospital for Special Surgery Charged in $1.4M Kickback Scheme
The former CEO of Hospital for Special Surgery in New York City, John R. Reynolds, was arrested and charged in a $1.4 million kickback scheme. Mr. Reynolds served as CEO from 1997 until 2006 and allegedly participated in three separate schemes during that time period.

5. Essentia Health Begins Repayment of $1.2M in Medicare Overpayments
Duluth, Minn.-based Essentia Health refunded $865,000 in Medicare overpayments after an audit found more than $1.2 million is overbillings. Essentia attributed the overpayments to clerical errors from its billing system. The company has since switched computer systems to correct the errors.

6. Valley, Englewood Hospitals Again Turn to Courts to Protest HackensackUMC's Pascack Valley Plans
Valley Hospital in Ridgewood, N.J., and Englewood (N.J.) Hospital and Medical Center requested a three-judge panel of the Appellate Division of Superior Court in Newark, N.J., to rule that the state health commissioner should reconsider her approval of Pascack Valley Hospital's reopening in Westwood, N.J. Health Commissioner Mary O'Dowd approved the reopening in February.

7. Lawsuit Alleging Wrongful Termination Against Pleasant Valley Hospital Remains Active
A lawsuit previously filed by two former employees of Pleasant Valley Hospital in Point Pleasant, W.Va., claiming they were fired based upon their sexual orientation, is still active and will go to the fifth judicial circuit court.

8. Bennett County Hospital in South Dakota Sues Indian Health Service for Payments
Bennett County Hospital in Martin, S.D., filed a lawsuit against the Indian Health Service saying the federal agency owes more than $1.65 million in uncompensated care for Oglala Sioux Tribe members.

9. Oklahoma AG Files New Lawsuit Against Affordable Care Act
Oklahoma Attorney General Scott Pruitt filed a lawsuit against the Patient Protection and Affordable Care Act, arguing that employers should not be penalized if they don't offer affordable health plans to their employees.

10. HCA Agrees to $16.5M Settlement Over Antikickback, False Claims Charges
Nashville, Tenn.-based Hospital Corporation of America, the U.S. Department of Justice and Tennessee agreed on a settlement in which HCA will pay $16.5 million for alleged violations of the False Claims Act and the Anti-Kickback Statute.

11. Delano Regional Medical Center to Pay $1M in Discrimination Lawsuit
Delano Regional Medical Center in San Joaquin Valley, Calif., will pay $975,000 to settle accusations of national origin discrimination. The lawsuit, filed by the U.S. Equal Employment Opportunity Commission and the Asian Pacific American Legal Center, alleges that approximately 70 Filipino-American employees endured harassment and discrimination, even from upper management officials at the hospital.

12. Louisiana Hospital Association Sues State Over Hurricane Isaac Policy
The Louisiana Hospital Association and the Louisiana State Medical Society sued state Insurance Commissioner Jim Donelon regarding a health coverage policy and Hurricane Isaac.

13. Prime Healthcare's Antitrust Lawsuit Against Kaiser, SEIU Dismissed
A federal judge rejected Prime Healthcare Services' November 2011 lawsuit against Oakland, Calif.-based Kaiser Permanente and the Service Employees International Union-United Healthcare Workers West, which centered on antitrust allegations.

14. Mass. Supreme Court Dismisses Safety-Net Suit Over Medicaid Reimbursement
The Massachusetts Supreme Judicial Court dismissed lawsuits filed by seven safety-net hospitals that claimed they were not reasonably reimbursed for Medicaid costs under the state's 2006 healthcare law.

15. Judge Dismisses Mississippi Governor's Suit Against Reform Law
A federal judge dismissed a lawsuit filed by Mississippi Gov. Phil Bryant that challenged the Patient Protection and Affordable Care Act.  U.S. District Court Judge Keith Starrett dismissed the suit, filed in April 2010, without prejudice, meaning the plaintiffs can file similar claims again. The judge said the issue was not matured for adjudication.

16. University of Iowa Sues Physician Over Non-Compete Agreement
The University of Iowa and Iowa Board of Regents have sued a former physician from UI Hospitals and Clinics, alleging he violated a non-compete agreement and has refused to pay liquidated damages that he agreed to in his contract.

17. Whistleblower Claims All Children's Hospital in Florida Overpaid Physicians
A former employee from All Children's Hospital in St. Petersburg, Fla., claimed the hospital overpaid its physicians in violation of anti-kickback laws.

18. Nearly 300 Patients Allege Unnecessary Heart Care at Saint Joseph-London in Kentucky
Attorneys filed suit on behalf of more than 280 patients who claim they received unnecessary heart procedures at Saint Joseph-London (Ky.) hospital. Although the details of the suits vary based on the claims of each case, overarching allegations include cardiologists installing unnecessary pacemakers and stents and performing unneeded cardiac catheterizations. Some patients also claim they underwent unnecessary open-heart surgery.

19. New York Downtown Hospital to Settle Kickback Allegations With $13.4M
New York Downtown Hospital agreed to a $13.4 million settlement to resolve allegations of Medicaid and Medicare fraud. Attorney General Eric T. Schneiderman alleged that NY Downtown Hospital entered into an illegal patient referral arrangement with SpecialCare Hospital Management Corporation, a for-profit vendor based in Missouri.

20. Patient Sues Cardiologist, St. John Medical Center in Cleveland Over Allegedly Unneeded Stent
A man sued cardiologist Harry Persaud, MD, and St. John Medical Center in Cleveland over allegations of an unnecessary heart stent procedure in February.

More Articles on Hospitals and Legal Issues:

5 Legal Issues Surrounding Electronic Medical Records
3 Core Legal Issues for Hospital Marketing Programs
3 Attorneys Discuss Trends in Hospital Litigation Today

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