“A federal district court in Massachusetts recently ordered Minneapolis based Coloplast to pay over $760,000 to Plaintiff, Amy Lestage, for retaliating against her after she and others filed a whistleblower complaint against the company,” reports Jolena Jeffrey in Katz, Marshall and Banks’ Whistleblower Law Blog.

“In December 2011, pharmaceutical whistleblower, Lestage, along with two former Coloplast employees filed a False Claims Act (FCA) qui tam action against the company, Byram Healthcare, and other large distributors of medical devices and services related to medical conditions and surgeries such as incontinence and ostomy.  The qui tam action alleged that Coloplast and some of its distributors engaged in an illegal kickback scheme to inflate their Medicare and Medicaid reimbursements and thereby defraud the federal government.  The qui tam action was unsealed on November 20, 2014, and the names of the relators, including Lestage, became public knowledge.”

Read the article.

“The three giant drug distributors are negotiating a deal with the states to end thousands of opioid lawsuits nationwide, in which they would pay $19.2 billion over 18 years and immediately submit to stringent monitoring requirements to assure that suspicious orders for prescription opioids would be halted,” reports Jan Hoffman in The New York Times’ Health.

“So far, 31 states plus the District of Columbia have tentatively agreed to the deal, while 19 states, including Florida, Connecticut and West Virginia, have not.”

Read the article.

“Disruptionware is defined by the Institute for Critical Infrastructure Technology (ICIT) as a new and “emerging category of malware designed to suspend operations within a victim organization through the compromise of the availability, integrity and confidentiality of the systems, networks and data belonging to the target.” New forms of disruptionware can be a more crippling form of cyber-attack than other more “garden-variety” malware and ransomware attacks.” warns an article in JDSupra.

“Generalized forms of ransomware attacks – designed to block access to the victim’s computer systems until money is paid – are continuing to represent a more prevalent threat to government agencies, healthcare providers and educational institutions … another publication has noted the rise of ransomware attacks since the beginning of 2019 finding that there have been at least 621 reported successful ransomware attacks against U.S.-based corporations. Of these attacks, at least 491 were targeted against healthcare providers, while another 68 of the attacks were directed at county and municipal institutions, and 62 of the attacks were focused on school districts.”

“The FBI’s PSA serves as a warning to businesses that they should have a plan in place to respond efficiently and appropriately in the event of high impact ransomware and disruptionware attacks.”

Read the article.

When considering employment by a hospital or health system, physicians should be mindful of various provisions that are often contained in physician employment agreements and how these provisions may impact the physician’s professional practice and personal life, advises McBrayer PLLC.

Christopher J. Shaughnessy discusses some important issues to consider when evaluating whether to enter into an employment agreement with a hospital or health system.

The article covers issues such as compensation, call coverage requirements, professional liability insurance coverage and “tail coverage,” and non-compete clauses.

Read the article.

A Miami-based personal injury attorney, a prostate cancer survivor, sued his health-care insurance provider in April, accusing it of wrongfully denying him and potentially thousands of other men coverage for a lifesaving prostate cancer treatment.

Richard Cole has had a hard time finding a judge to hear his case, if only because they all keep recusing themselves, reports The Washington Post.

Then one judge, who also felt he had to recuse himself and who was a prostate cancer survivor himself, made it clear how he felt about the case. In his recusal order, U.S. District Judge Robert N. Scola Jr. wrote “To deny a patient this treatment, if it is available, is immoral and barbaric.”

Read the Post article.

The 5th U.S Circuit Court of Appeals has affirmed a 2016 jury verdict and 2017 trial court judgment that ultimately awarded $9.5 million to a Dallas-based health care company, according to a post on the website of Androvett Legal Media & Marketing.

In a majority opinion, the appellate court found that BlueCross BlueShield of Louisiana failed to properly reimburse Encompass Office Solutions for in-office medical procedures, and distributed a defamatory letter to physicians with false information regarding the company and its services. That letter threatened to terminate the network contracts of doctors who continued to work with Encompass.

Subsequent to the opinion in the case, the court has denied a motion for rehearing.

A trial team from Thompson & Knight LLP represented Encompass throughout the district court hearings and before the 5th Circuit.

“This case has a lengthy history spanning several years, and we’re pleased that finally Encompass will be properly compensated for the services it provided and the damages the company has incurred,” said Jennifer Rudenick Ecklund, a trial partner at Thompson & Knight who argued the case before the trial court and 5th Circuit. The judgment remains subject to the awarding of interest and legal fees to Encompass.

Other members of the Thompson & Knight trial team included William L. Banowsky, Andrew C. Cookingham, Greg W. Curry, Richard B. Phillips, Jr. and Reed Randel.

Encompass provides mobile ambulatory surgery services that allow doctors to safely perform surgeries in their offices. Encompass’s business is primarily focused on women’s health, allowing patients to have sensitive gynecological procedures done in the comfort and safety of the doctor’s offices while providing the necessary anesthesia care. This method reduces the infection risks associated with hospitals and ambulatory surgery centers, and provides both doctors and patients with a more efficient and cost-effective means of delivering medically necessary surgical care.

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The Oklahoman reports that jurors wanted to send a message to health insurer Aetna after hearing how the company’s overworked doctors denied an Oklahoma cancer patient’s claim for coverage for proton beam therapy.

Reporter Nolan Clay writes that jurors awarded $25.5 million to the patient’s estate and to her husband, a retired Oklahoma City firefighter, in the bad-faith case against the company.

The patient, Orrana Cunningham, died in 2015 from a viral outbreak after getting treatment for the tumor in her head and returning home. She was 54.

Read the Oklahoman article.

An El Paso neurosurgeon is the subject of a lawsuit filed last week, accused of unlawfully conspiring with a local attorney to solicit legal representation for a dying truck wreck victim, according to a release from Androvett Legal Media & Marketing.

The lawsuit, filed by El Paso resident Karla Triana, claims that while her mother was undergoing emergency surgery at Del Sol Medical Center, Dr. Bratislav Velimirovic handed her a lawyer’s business card and urged her to contact the attorney. Triana’s mother died as a result of her injuries.

Triana subsequently received a call and text message on her personal cell phone from an employee in the office of the attorney, Victor J. Bieganowski, indicating that he sought to represent her in a civil claim against the trucking company.

“It’s clear that the doctor and the attorney are breaking the law by working together to solicit legal representation of accident victims and their families,” says attorney Tom Carse of Dallas. Carse handles cases involving charges of unlawful representation, known as barratry, against other attorneys, according to the release.

“It’s logical to think this was not an isolated incident, and that there may be more instances of this conspiracy still to be uncovered.”

The release states that Bieganowski was convicted in 2000 on federal charges for his role in a massive medical and legal fraud, and received a 30-month prison sentence and a fine of $375,000. He was disbarred, but subsequently regained his law license. The fraud charges involved claims against union officials for funneling the cases of injured workers to Bieganowski’s legal practice and the medical practice of his brother, Dr. Arthur Bieganowski.

Dr. Velimirovic is a partner in Neurosurgical Specialists of El Paso. According to the clinic’s website he is a “board-certified neurosurgeon who utilizes advanced techniques to perform minimally invasive spine surgery, cranial surgery and interventional radiologic procedures.”

MedCity News reports that one of the nation’s largest dialysis providers will pay $270 million to settle a whistleblower’s allegation that it helped Medicare Advantage insurance plans cheat the government for several years.

Fred Schulte explains:

The settlement by HealthCare Partners Holdings LLC, part of giant dialysis company DaVita Inc., is believed to be the largest to date involving allegations that some Medicare Advantage plans exaggerate how sick their patients are to inflate government payments. DaVita, which is headquartered in El Segundo, Calif., did not admit fault.

Read the MedCity News article.

Jurors took just eight hours to award a Brooklyn couple $26 million — double what they had sought — after overwhelmed medical residents at Maimonides Medical Center allegedly botched the birth of their twins, leaving one dead and the other deaf and mute, reports the New York Post.

Under a “high-low” agreement struck earlier by both sides, the plaintiffs agreed to receive a “high’’ of $7.5 million if they won their suit and a “low’’ of $1.5 million, even if they lost, according to reporter Julia Marsh.

In 2010, the expectant mother went to the hospital twice with cramping and spotting but was sent home by doctors-in-training, according to the lawsuit. When her twins daughters were born later, they weighed about 1.5 pounds each. A month later, one died from an infection, and the other is deaf and suffers from kidney failure.

Read the Post‘s article.

A bill in the Texas House seeks to end regulations that require nurse practitioners to contract with doctors in order to treat and write prescriptions. The proposal, HB1415, would give nurse practitioners (NPs) in Texas the freedom and flexibility they have been seeking for decades, reports Androvett Legal Media & Marketing.

It also would cut costs for both patients and providers, according to attorney Bill Hopkins of the Austin office of Shackelford, Bowen, McKinley & Norton, LLP.

“From the start, there has been a fundamental tension between their role and the role of the physician in the health care setting,” says Hopkins, who advises both individual and institutional health care providers on matters involving administrative law, regulatory defense and litigation. “No one has ever questioned that the physician is at the top of the pyramid. But over the years there has been some question as to whether there was some room at the top for the nurse practitioner who can drastically improve access to care.”

Currently NPs must complete four years of nursing school and two years in a graduate-level training program. Although they are regulated by both the Texas Board of Nursing and the Texas Medical Board, regulations require a doctor to supervise – even if the physician is not physically present and does not even see the patient, says Hopkins. Similar regulations have been rolled back in other states, with no evidence of increased safety issues, he says, adding that in some studies, nurse practitioner safety has ranked as high or higher than doctor care.

“For many years, NPs have argued that their knowledge, ability and training were more than sufficient to allow them to practice independently, care for patients and ensure safety,” he says. “The justification for charging NPs for this ‘supervision’ traditionally has been that it is a necessary cost to ensure patient safety. But thanks to the Affordable Care Act, there are more people with insurance than ever before and access has become a primary concern. With the safety argument becoming less relevant and calls for better access getting louder, it looks like this may be the time for NPs to finally get the independence that they have sought.”

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Compliancy Group will present a complimentary webinar examining the major breaches and fines that made 2016 the most expensive year on record for HIPAA fines and enforcement.

The event will be Wednesday, Jan. 25, at 2 p.m. Eastern time.

HIPAA experts at Compliancy Group will analyze the causes of these breaches, the reasons for these substantial fines (almost $24 million in total), trends in compliance, and what to expect from OCR investigations in 2017.

Register for the webinar.

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It’s hard to predict exactly what President-elect Donald Trump wants in a new health care law, but a repeal of the Affordable Care Act (ACA) is rapidly on track in Congress, according to a report published on the website of Androvett Legal Media & Marketing. Dallas health care lawyer Jeff Drummond of Jackson Walker LLP, who represents doctors, hospitals and other health care facilities, has some predictions about what to expect:

“Repeal is almost entirely certain, and will be near immediate with the new Congress. It will be done using the same reconciliation technique that allowed ACA to pass in the first place, thus avoiding the filibuster and the need for 60 votes in the Senate.

“The changes likely will be phased in over time, with very few, if any, immediately repealed. That will allow the new Congress time to fashion replacement parts. And those replacement parts will mostly resemble the old law.

“For example, the new law will allow insured parents to keep their children on their policies until age 26. It also will likely preserve the ban on lifetime limits.

“The new law will drop the individual mandate to buy health insurance. But coverage for pre-existing conditions will be more like the portability requirement under the Health Insurance Portability and Accountability Act (HIPAA). That law requires insurers to accept people with existing health problems only when they previously had coverage, such as from their current or former employer. So people with pre-existing health conditions now covered under individual policies through the ACA would be eligible for coverage under the new law, but individuals who did not previously have coverage would be subject to potential exclusion for pre-existing conditions.”

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The president and chief operating officer of Texas-based Adeptus Health is the latest executive out the door at the nation’s largest operator of freestanding emergency facilities, reports The Dallas Morning News.

Graham Cherrington is the second executive to leave the embattled company suddenly in recent months, following a disappointing $11.7 million loss in third quarter. He follows longtime chief executive officer Thomas Hall, whose retirement was accelerated to November, writes reporter Sabriya Rice.

“The company went public with its freestanding emergency room model in June 2014, and now operates more than 90 facilities across the United States.  In 2015 it generated $365 million in revenue,” she writes. “Shares plummeted in November following the disappointing loss and an unexpected request to secure $27.5 million in emergency financing from investors.”

Read the Dallas News article.

Gritstone Oncology, a cancer immunotherapy company developing next-generation, personalized cancer therapeutics, has announced a Series A financing of $102 million. The financing will support discovery and development of novel tumor-specific neo-antigen (TSNA) based immunotherapies, with an initial focus on lung cancer, the company said in a release.

Latham & Watkins LLP advised Gritstone Oncology in its formation and the Series A financing with a corporate team led from the firm’s Silicon Valley office by partners Alan Mendelson and Brian Cuneo, with associates Alexander White and Kevin Tsai.

The financing was co-led by biotechnology investors Versant Ventures and The Column Group, with Clarus Ventures alongside. Other investors include Frazier Healthcare Partners, Redmile Group, Casdin Capital, and Transformational Healthcare Opportunity, a special-purpose vehicle for private investors.

“We are honored that this discerning group of investors recognized the tremendous potential that exists both in our approach and our team,” said Andrew Allen, M.D., Ph.D., Gritstone Oncology co-founder, president and CEO. “We believe that this substantial funding, along with our best-in-class expertise, a systematic discovery and development approach, and our commitment to do the scientific heavy-lifting required, will enable us to solve the core challenge of identifying personalized, therapeutic neo-antigens for individual patients.

“Cancer immunotherapy is an exciting area of discovery, and an ability to predict the antigens recognized by T cells that drive tumor elimination is likely fundamental to continuing advances in the field,” said Allen. Gritstone will focus initially on discovering and developing TSNA-based therapies for non-small cell lung cancer (NSCLC).

Compliancy Group will present a complimentary webinar Thursday, Oct. 22, 2-3:30 p.m. EDT, to discuss how a medical practice can measure, control and protect the practice’s reputation.

“Can you name the one thing in your practice that can dictate everything from new patient referrals to insurance contract negotiations and recruiting of staff and providers?” the firm asks.

“Your practice’s online reputation is your most important asset, yet it is often ignored, unmanaged or neglected.”

David Brooks, VP, Marketing, Doctor.com, will discuss:

• How patients, insurance carriers, and potential employees evaluate the reputation of your practice
• Five things you can do right now to improve the way search engines view your practice’s reputation
• The best practices that define high-performance practices

The webinar is limited to medical practice owners and senior practice management executives.

Register for the webinar.