Business Law Health Law Committee

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

The Federal Nursing Home Reform Amendments (FNHRA) impose various requirements on nursing homes receiving reimbursement under Medicaid. As pertinent here, they require a nursing home that transfers, discharges, or refuses to readmit a hospitalized resident to inform the resident of his or her right to appeal that decision. The state-established appeals process must provide a “fair mechanism” by which residents may challenge a decision. Read more

Health and Safety Code § 1418.8 requires an interdisciplinary team (IDT) to make healthcare decisions for “unbefriended” nursing home residents who lack capacity to make those decisions. A nursing home resident, a taxpayer, and the California Advocates for Nursing Home Reform petitioned for a writ of mandate against the Director of the Department of Public Health (Department) challenging the constitutionality of section 1418.8. The superior court granted the petition, ruling that section 1418.8 was unconstitutional because it (1) facially violated due process by failing to require notice to a resident of a physician’s determination that the resident lacks capacity, has no surrogate decisionmaker, needs a recommended medical intervention, and has a right to judicial review; (2) violated due process when applied to authorize an IDT to make decisions about administering antipsychotic medication; and (3) violated the patient’s privacy rights regarding end of life withdrawal of care decisions. The court entered judgment and prohibited enforcement of section 1418.8 to the extent it conflicted with those rulings. Both parties appealed. Read more