Here are 11 court cases involving the healthcare industry to know, as reported by Becker's since Jan. 25:
1. Fifteen people were sentenced to pay more than $8.3 million combined in restitution for their roles in an insurance scam that defrauded at least five companies of approximately $40 million. Between 2015 and 2020, the defendants operated an illicit call center, durable medical device company and six pharmacies in Southern California in which they targeted patients and billed for fraudulent prescriptions.
2. Two physicians, along with two other individuals, were indicted by a grand jury on charges of federal violations connected to a university athletics department billing scheme. Mouzon Bass and Lance Wilson allegedly used their company Vivature to submit false claims to private insurance carriers. The claims purported that physicians — including Kyle Carter, MD, who was indicted separately last year, and Robert Scott, DO — were providing medical treatment to student-athletes across the U.S., despite the providers never providing care to the student athletes.
3. Home health company owner Yogesh Pancholi was sentenced to nine years in prison for a healthcare fraud and wire fraud scheme. Mr. Pancholi owned and operated Livonia, Mich.-based Shring Home Care through which he and his co-conspirators billed and were paid nearly $2.8 million in fraudulent Medicare claims. He then transferred these funds through shell companies' bank accounts and eventually into his accounts in India.
4. Imran Shams, a medical lab operation in Glendale, Calif., was sentenced to 10 years in prison for conspiring to conceal his role in a billing scheme that defrauded Medicare of approximately $234 million. He and a co-conspirator operated a lab and submitted fraudulent claims to Medicare while concealing Mr. Shams' involvement.
5. The Delaware Supreme Court ruled that financial services company Cantor Fitzgerald properly denied $9 million to former partners under noncompete agreements. The decision, which upended a lower court's ruling, said the company's noncompete provisions were not too broad and applied to a range of "competitive activity." The court also ruled that when a partner moves to a competing firm, Cantor was not required to grant a deferred benefit to the partner because they agreed to forfeit it.
6. Silver Spring, Md.-based physician Ishtiaq Malik, MD, was found guilty of sexually assaulting two patients. A total of 11 victims came forward. He was convicted on two counts of second-degree rape and two counts of fourth-degree sex offense, and he entered a plea for eight counts of fourth-degree sex offense for the other victims.
7. Ray Shoulders, a physician assistant in Fort Worth, Texas, was convicted of 12 counts of healthcare fraud for injecting amniotic fluid into patients in an attempt to manage pain. Mr. Shoulders and his conspirators submitted $788,000 in fraudulent claims and received more than $614,000 in reimbursements for injecting amniotic fluid to relieve pain, despite the treatment not being FDA-approved for that purpose, making it ineligible for Medicare reimbursement.
8. Jimmy Collins and Ashley Collins, a married couple living in Birchwood, Tenn., were sentenced to prison and home confinement, respectively, for a $65 million Tricare fraud scheme. The couple admitted in July that they worked to recruit sham Tricare beneficiaries to receive expensive medications in return for $300 kickbacks.
9. The Federal Trade Commission sued Charlotte, N.C.-based Novant Health to block its $320 million bid to purchase two area hospitals and build a new ASC in Mooresville, N.C. The FTC's complaint alleges that Novant already operates a medical center just 11 miles away from Lake Norman, and it is among the largest systems in the Southeast. The FTC complaint also says Novant is "one of the most expensive hospital systems in North Carolina."
10. The North Carolina Supreme Court granted review for a lawsuit from Jay Singleton, MD, who owns an ophthalmology practice in New Bern, N.C., challenging the state's certificate-of-need laws. The suit's most recent opening brief alleges the certificate-of-need laws violate the state's law-of-the-land clause in how it is not "reasonably necessary to protect the public" and the exclusive privileges and anti-monopoly clauses because the law grants an exclusive right to provide private services. A response from the state argues the court should affirm the judgment because the plaintiffs failed to exhaust administrative remedies, and failed to state a valid claim under both the law-of-the-land clause and the exclusive-emoluments and anti-monopoly clauses.
11. Charles Turner pleaded guilty to a 2021 stabbing that occurred inside Mercy Surgery Center-Springfield (Mo.). Mr. Turner faced a first-degree domestic assault charge after stabbing a Mercy employee on Oct. 8, 2021. The victim, who shares a child with Mr. Turner, survived the attack.