Business Law Health Law Committee

A resident at ResCare, a long-term health care facility, developed a history of maladaptive and self-injurious behavior. However, his physicians did not classify him as a suicide risk and did not order any special measures beyond medication. Although ResCare had nursing care and behavior plans in place and monitored the resident frequently, he choked to death on a small towel left within his reach. The Department of Public Health cited ResCare for violating two regulations (Cal. Code Regs., tit. 22, §§ 76918, subd. (a), 76875, subd. (a)(2)) by failing to ensure that the resident was free from neglect and protected from injuring himself. ResCare sued the Department to challenge the citation. Read more

Dr. Novarro Stafford is a retired anesthesiologist whose clinical privileges were terminated by the medical staff at USC Medical Center prior to his retirement. While Dr. Stafford worked at the Medical Center, a female patient had complained that Dr. Stafford had acted inappropriately during an examination. The medical staff summarily suspended Dr. Stafford’s privileges and referred him for a neurocognitive evaluation. The medical staff then terminated Dr. Stafford’s privileges after he failed to timely submit to the evaluation. Dr. Stafford appealed and requested an administrative hearing. A hearing officer (James Lahana) was appointed. Read more

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