Recently in Medicare/Medicaid Category

February 12, 2011

U.S. Government to Pay $2.3 Million in Malpractice Case

The federal government will pay $2.3 million to settle a medical malpractice lawsuit involving a child born with neurological damage at Portsmouth Naval Medical Center. U.S. District Judge approved the settlement between the Justice Department and a family in Virginia Beach, according to a court filing made public. The plaintiffs sued the United States early last year, seeking $15 million in damages. The couple alleged that inadequate care at a Naval Medical Center caused their child to be born with developmental disabilities. The government denied any malpractice and admited no wrongdoing in the settlement.

In 2006,the plaintiff checked into the hospital with severe cramping in her lower abdomen. She was 35 weeks pregnant, according to the lawsuit. She was moved to a triage room and connected to a fetal heart monitor, which showed abnormalities indicating the fetus was under stress, the suit says. Instead of notifying a doctor, the papers say, the staff left the patient for more than an hour without any intervention.

About 2-1/2 hours after she was admitted, doctors performed an emergency cesarean section. The doctors determined that the placenta had detached from the uterine wall, causing a loss of oxygen to the fetus, the suit says. The baby girl was born pale and limp, with respiratory failure and a slow heart rate, the suit says. She was intubated and later transferred to Children's Hospital. The girl's "neurological injuries are extensive, severe and permanent," the suit says. "She is severely delayed in all areas of development." The damage, including cerebral palsy, will be lifelong.

The case was set for trial Dec but the parties had been working on a settlement for at least two months, the court records show. A spokesman for the U.S. attorney's office, which defended the suit, declined to comment. Attorneys for the plaintiffs did not return phone messages. The judge's settlement order states that the plaintiff's attorneys will receive about $675,000 in fees and expenses, $54,000 will go toward medical bills, and the remaining $1.57 million will go into a trust set up to care for the child.

If you or a loved one has been wronged by a medical mistake call my offices for an initial free consultation at 1-800-320-0080 located in Baltimore or Rockville for immediate consultation.

February 7, 2011

Jury orders drug company to pay $170 million in Medicaid fraud case.

In what state officials describe as a record-setting verdict, a jury found that a global drug manufacturer misrepresented prices to the state's Medicaid program and said the company should pay the state and federal government $170.3 million. The verdict concluded a nearly three-week trial in state district court, where lawyers for the attorney general's office argued that the drug company artificially inflated the costs of medications to obtain more money. Medicaid reimbursed pharmacies at higher rates because of the falsely reported prices, officials said.

The trial reportedly was the first of its kind in the state; similar cases in recent years have settled out of court. The attorney said in a statement that the case makes clear his office will hold accountable those who defraud the Medicaid program, a joint federal and state effort to provide health coverage to needy Americans. "Considering the hundreds of millions of dollars that are at stake, we will continue to vigilantly pursue providers that falsely report prices to defraud the taxpayers," he said.

Drug company officials said in a statement that they are disappointed by the verdict and are exploring legal and appeal options. "We remain, as always, committed to offering high-quality, lower-cost alternatives for health consumers, including the millions of Americans who participate in the Medicaid program," said the company's vice president and chief legal officer.

The verdict stemmed from a sealed whistle-blower lawsuit -- filed in 2000 by a pharmacy, that accused a number of drug-makers of reporting inflated drug prices to the Medicaid program. They joined the lawsuit in 2000 and reached settlements with 11 companies, settling for more than $139 million. In 2008, the state increased pressure on the drug companies and three other drug-makers -- and began to discuss settlements or possible trials.

If you suspect fraud that may affect your right call me at 1-800-320-0080 or call for an appointment at my offices located in Rockville or Baltimore for an initial free consultation.

January 12, 2011

Substandard Care at Medical Facility Led to Deaths

Two doctors and a medical assistant have filed a workplace discrimination lawsuit against a Medical Center, claiming that more than one patient has died there as a result of "substandard care" and that they were ignored or embarrassed, and in one case, terminated, for speaking out. The County Executive said several outside and internal inspectors found "absolutely no evidence'' that the patients in question died because of negligence. But he acknowledged that the hospital's cardiology department is "dysfunctional" because of the many "personality conflicts" and "plethora of he-said, she-said arguments."

Lawsuit filed Friday in U.S. District Court offers a rare glimpse into the mostly private goings-on in the county-run hospital hallways. Seventy-four pages of allegations paint a one-sided picture of death, backbiting and sexism. The suit was brought by a medical administrative assistant in the cardiology department; a cardiologist; and a chief of cardiothoracic surgery. "This was a last resort,'' said the attorney "But the plaintiffs felt this was a moral imperative that they come forward. We have to tell the community what is going on here, that people are dying, and the administration will not change."

Named as defendants are a chief of cardiology; a chief medical officer; a medical director; and a cardiologist. Among other things, the suit alleges retaliation, discrimination, a hostile work environment, invasion of privacy, slander and intentional infliction of emotional distress.
One of the most serious allegations stems from the death of an unnamed patient in February 2009. The doctor said she advised the patient not to get a stress test on his heart because of his fragile health and history of family heart attacks. she said she recommended a "cardiac catheterization" instead. But other cardiologists ignored the patient's wishes and her advice, the lawsuit alleges, and gave the patient a stress test anyway. The patient suffered cardiac arrest and died.

Both doctors allege that they were retaliated against by being ignored, verbally abused and embarrassed in e-mails, among other things, as a result of filing complaints with the Joint Commission of Accreditation Health Organizational regarding what they felt was "substandard" patient care. This allegation does not surprise the D.A. who was well aware of this complaint, and many others that the three plaintiffs have filed with county, state and federal officials. He said the negligence allegations have been thoroughly investigated internally and by outside experts, and they found "absolutely no evidence of poor or detrimental care."

The third plaintiff states that in April 2008 he had wanted to perform surgery on a heart patient sooner rather than later, but "administrators denied him that possibility," and the patient died, the suit alleges.He said after he spoke out about this, he was slandered in public and that his contract wasn't renewed because of it. His last day of work will be in June, his lawyer said. The county executive insisted that none of the "three individuals" have been retaliated against, although he acknowledged that from their point of view, they probably would have liked to see more done on their behalf. Smith said the decision not to retain the Dr. was a cost-cutting move since the number of cardiac surgeries has been declining.

"This lawsuit is the last forum available to them," he said. "I'm not surprised, I'm disappointed." As with all lawsuits lawsuits and appearance in court is the last recourse for any litigant and you must make it count. If you or a loved one has been injured as a result of professional negligence or anothers conducts' ccontact my offices conveniently located in Rockville or Baltimore for a free initial consultation or call me at 1-800-320-0080.

October 2, 2010

Pharmaceutical company sued for overbilling Medicaid

A major pharmaceutical company has entered into settlement agreements worth more than $21 million from charges that the firm overcharged Medicaid programs of Michigan and Massachusetts. The settlement by the nation's largest provider of pharmaceutical care for the elderly stems from a whistleblower lawsuit filed in federal court in 2003 by a former financial analyst. The pharmaceutical company was accused of not following "usual and customary" pricing regulations when charging Medicaid for prescription drugs supplied to residents of skilled-nursing facilities in the two states. In one instance, the whistleblower complaint alleged that in 2001 the pharmaceutical company was paid by private insurers an average of $27.75 per prescription, while its payments for Medicaid patients averaged $47.15 per prescription, according to a Washington-based whistleblower law firm that represented the former financial analyst. Under the settlement announced Tuesday, the pharmaceutical company will pay $9.45 million to Massachusetts and $11.6 million to Michigan. The settlement also requires the company to comply with pricing regulations, which include billing the lowest price the company charges a private third-party customer for the same drug. The pharmaceutical company denied any wrongdoing and cooperated during the investigation, according to a release from the Attorney General's office.
In a filing with the Securities and Exchange Commission, the company said that the settlement agreement with Michigan and Massachusetts includes a provision to dismiss claims against the company included in another whistleblower lawsuit that is pending in Illinois related to the same charges. In recent years, legal troubles have cost the pharmaceutical company millions. Among other settlements, they paid $98 million last November to settle a whistleblower lawsuit that charged the company accepted kickbacks from a drug giant corporation.They admitted no guilt in the case. As part of that settlement, five whistleblower lawsuits were dismissed. If you suspect any fraud by a company or an insurance company call me at my offices located in Rockville or Baltimore at 1-800-320-0080 for a free consultation.