Business Law Health Law Committee

Dr. Emil Soorani, a psychiatrist, was investigated by the Medical Board after it received information he was overprescribing controlled substances. The Board obtained a Controlled Substance Utilization Review and Evaluation System (CURES) report detailing his prescribing history. The Board’s medical consultant identified six patients who were prescribed controlled substances in large quantities or with “erratic patterns.” Read more

States participating in the federal Medicaid program must pay federally qualified heath centers for the services they provide to Medicaid beneficiaries. California participates through Medi-Cal. Under Medicaid, California must pay such health centers 100 percent of their costs of furnishing required services. Tulare Pediatric Health Care Center (the Clinic) is a federally qualified health center. Read more

The Board of Pharmacy filed an accusation against Solomon Oduyale, a licensed pharmacist, to revoke or suspend his license. The accusation was based on 16 causes for discipline ranging from possession of controlled substances without proper labeling to failure to maintain accurate and complete pharmacy records. After a hearing, the Board adopted an ALJ’s decision proposing revocation of Oduyale’s license and a stay of the revocation with probation for three years. Read more

The California Insurance Guarantee Association (CIGA) is a state-run entity that pays covered claims against insolvent insurers. California law prohibits CIGA from reimbursing state and federal agencies, like Medicare. In contrast, the Medicare Act contains a Secondary Payer Provision that requires a primary insurer to reimburse Medicare for any medical care included under the beneficiary’s policy with a primary insurer. Read more

Unruh Act forbids religious hospital from denying treatment based on gender identity without providing treatment at comparable facility. Read more

Hospital cannot contractually avoid statutory notice and hearing requirements governing medical staff peer review. Read more

Residential drug treatment facilities violating zoning ordinances may be enjoined as per se nuisances. Read more

Geraldine Godecke worked as the Director of Medicare Cash and Collections at Kinetic Concepts, Inc. (KCI), a company that manufactures vacuum-assisted wound closure equipment. To receive payment from Medicare, KCI must obtain a physician’s written order before delivering equipment to a patient. After KCI fired her, Godecke (as a relator) filed a whistleblower suit under the federal False Claims Act. She alleged that KCI submitted claims to Medicare for equipment delivered to patients before it received a physician order, using billing codes incorrectly indicating that all reimbursement requirements were met. The district court granted KCI’s motion to dismiss, ruling that Godecke did not plausibly allege that KCI submitted claims with improper billing codes, or acted with scienter. Read more

Plaintiff Alycesun Daley was pregnant with twins who suffered from twin-twin transfusion syndrome (TTTS), a congenital condition involving inter-twin vascular connections. As part of a National Institute of Health clinical study, she underwent two fetoscopic laser surgeries to treat the TTTS at UCSF’s Fetal Treatment Center. After the second surgery, she developed a bacterial infection which led to an induced delivery. Neither twin survived. Read more

Matthew Omlansky, a relator, brought a qui tam action against Save Mart Supermarkets alleging False Claims Act violations for seeking reimbursement for prescription and nonprescription medications sold to Medi-Cal patients at rates higher than the rates charged to customers paying cash. Specifically, Omlansky alleged this practice violated a 2009 state statute capping Medi-Cal billings at Save Mart’s “usual and customary price.” (See Welf. & Inst. Code, §§ 14105.45, subd. (b), 14105.255, subd. (b).) The trial court sustained Save Mart’s demurrer and Omlansky appealed. Read more