Rosen pleased guilty to participating in a scheme which involved former state Sen. Carl Kruger (D-Brooklyn), Assemblyman William Boyland Jr., (D-Brooklyn) and the late Assemblyman Anthony Seminerio (D-Richmond Hill). The scheme funneled hundreds of thousands of dollars to the politicians in return for using their influence in Albany to benefit Rosen’s healthcare organization.

At Rosen’s request, he was tried before a judge rather than a jury. After a three-week trial last year, Judge Jed Rakoff found him guilty.

His lawyer, Elkan Abramowitz, argued that Rosen did what he had to do to secure the survival of his hospitals — which served New York’s poor — and that he didn’t ask for any of the money for himself. He also asked the judge to let Rosen off on probation and community service.

The courts probation office recommended a sentence of 10 years.

The NYDailyNews reported that Judge Rakoff said that while he had no doubt Rosen was “a good man in many respects,”  the seriousness of the crimes required him to send Rosen to prison. Rakoff added this case was tragic because it showed how someone who had been widely admired and sought to better the health care of poor communities used his position to bribe state legislators.

After serving three years in prison, Rosen will also spend two years under supervised release and is required to pay a $500 special assessment fee.

Rosen maintains his innocence. That’s why Abramowitz told the judge he would be filing an expeditious appeal on Rosen’s behalf.

Kruger resigned and pleaded guilty to corruption charges in December and was sentenced to seven years in prison. Boyland was acquitted, but later arrested on new bribery charges. Seminerio, plead guilty to an earlier case of fraud and died in prison.

What’s your opinion on this case? Share your thoughts in the comments section below.

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Should nurses be allowed to administer anesthesia without a doctor’s supervision?

This is a debate that’s been plaguing hospitals around the country. It started in 2001 with a change to Medicare and Medicaid regulations. The change allowed states to opt out of a requirement that nurse anesthetists be supervised.

Many believe this is a good change. Reason: It gives increased access to healthcare for people in rural areas who have to travel outside their local community to find a facility that has an anesthesiologist.

The two sides of the debate are:

• Nurse anesthetists, who specialize in administering anesthesia. Argument: They are highly capable of administering anesthesia without the supervision of a physician, because they learn about the same drugs, equipment and standards of care as physicians do.
• Anesthesiologists, who are physicians who specialize in administering anesthesia. Argument: Anesthesia is a complex and technically demanding area of medicine that requires the skill of a physician, or at least the supervision of a physician, in case complications arise.

Colorado is one of 17 states that have decided to allow nurse anesthetists to administer anesthesia without physician supervision. Due to this decision, the state finds itself embroiled in a legal battle.

In 2010, anesthesiologist and medical societies filed a lawsuit in state court. The lawsuit asserted that allowing nurse anesthetists to deliver anesthesia without supervision wasn’t consistent with state law — a requirement for opting out of the federal rule.

However, the lawsuit was dismissed. A judge ruled the legislature did intend for the practice to be allowed. But that didn’t stop the medical societies. They appealed the ruling last May. Nationally, both sides are keeping a close watch on this case.

Colorado isn’t alone. The California Society of Anesthesiologists petitioned the State Supreme Court to take another look at its 2009 lawsuit for opting out of the supervision requirement. Much to the chagrin of the California Hospital Association, the suit hasn’t been successful. The association is on the nurses side due to the difficulty it’s had staffing anesthesiologists in facilities in California’s rural areas.

Where does your facility stand on this debate? Share thoughts in the box below.

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“Wrong setting” denials – where a RAC audit determines that services were provided in a medically unnecessary setting.

So why are RACs targeting hospitals?

It’s simple – it’s lucrative. The Centers for Medicare & Medicaid Services (CMS) pays a contingency fee to RACs for finding and collecting overpayments. So they go after high-dollar inpatient services.

According to Craneware InSight’s whitepaper, RAC Best Practices: Utilization Management, many facilities make themselves easy targets for RACs because they only use one set of criteria to assess inpatient admissions.

To “RAC-proof” your facility’s admission screening criteria, industry expert Karen Bowden, RHIA, who has 25 years of hospital administrative experience, suggests hospitals use the following three steps to supplement published inpatient screening criteria:

1. Adopt All procedures on “inpatient only” published lists from Medicare, payors with such lists, and ones in proprietary screening criteria.
2. Have your utilization review committee develop and approve leveling criteria for all procedures that, depending on the circumstances, can be performed and billed as an in- or outpatient. When researching these procedures, look for diagnosis combinations that can increase the risk of complications and death, and require additional monitoring and/or interventions.
3. Implement a second-level review by a case manager. The cases that should undergo a second-level review include those that:
   • don’t meet “inpatient status” admission screening criteria, but the case manager believes — based on clinical documentation — should be classified as inpatient
   • are categorized as inpatient, but the original case manager feels should be observation status. In these cases, if the second-level reviewer agrees, the cases go to a physician advisor before any status changes are made, and
   • involve observation patients in a nursing unit bed.

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This settlement resolves allegations – made under the False Claims Act (FCA) – that Tenet overbilled Medicare for the treatment of patients at inpatient rehabilitation facilities (IRFs).

The allegations stem from admissions at 25 IRFs between May 15, 2005 to Dec. 31, 2007. According to the Justice Department, the Dallas-based hospital operator billed Medicare for patients who didn’t meet the standards for admission to IRFs. And since IRFs are designed for patients who require more intense therapy and closer medical supervision, they get paid more than acute care hospitals or skilled nursing facilities.

This settlement is part of the government’s 2009 Health Care Fraud Prevention and Enforcement Action Team (TEAM) initiative and its effort to reduce and prevent Medicare and Medicaid financial fraud. To date it’s the single largest U.S. recovery involving inappropriate inpatient rehab admissions.

Tenet self-disclosed the overbilling because it was required by the corporate integrity agreement it was operating under.

Tenet officials said they’d already set aside the funds for the settlement, and will pay it in the second quarter.

Under the FCA, the Justice Department has recovered more than $6.6 billion since January 2009 in cases involving fraud against federal healthcare programs.

Currently, Tenet runs 50 hospitals, close to 100 outpatient health centers, but only eight IRFs.

What do you think about the settlement? Is the government making an example of Tenet or is it fair? Share your thought below in the comments box.

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Anna Brown had gone to three hospitals in the course of a week seeking treatment for a sprained ankle that had gotten increasingly painful — to the point that she was using a wheelchair to get around.Within hours of being kicked out of the last ER as a “drug-seeker,” she was found dead on the floor of her jail cell. Cause of death: blood clots that had traveled from her legs to her lungs.

Now her family would like to know just what went wrong.

Here first hospital visit, to St. Louis University Hospital, began last September 13. She stayed for two days for additional testing, but hospital officials said there was no indication at that point that she had a blood clot in her leg.

Four days after she was discharged, she arrived on crutches for what would turn out to be her final visit with her children, ages 11 and 2.

On Sept. 20, she went back to SLU Hospital complaining of knee and ankle pain. Doctors there said X-rays were negative and she was given painkillers — but she refused to leave the hospital, claiming that they hadn’t sufficiently treated her. After police arrived, she wheeled herself to a nearby pediatric hospital. Doctors there found she had significant tenderness in both legs. Eventually she was taken by ambulance to St. Mary’s Hospital in Richmond Heights, Missouri.

Doctors there said that ultrasounds of both legs were negative for blood clots. A social worker at the hospital gave her a list of local shelters and a number to call for transportation. Brown left, but returned within a few hours, complaining of continued pain. The hospital discharged her at 7 a.m., but Brown refused to sign the papers.

Shortly after, the hospital called police to have her arrested for trespassing. Brown complained repeatedly that she was in severe pain, could not stand and needed further medical care. Instead, a doctor at the hospital issued a “Fit for Confinement” report, indicating that Brown was well enough to be arrested.

Police had to literally pull Brown from the patrol car and into jail. Notes in her booking report listed “suspected drug use” and “unknown leg pain.” Brown was carried into a cell and left on her back on the floor of the cell.

An officer monitoring the cell by camera noted that she was moaning and moving slightly — until she stopped moving around 2 p.m. The officer thought she had fallen asleep. Fifteen minutes later, she was found unresponsive and attempts to revive her failed. She was taken back to St. Mary’s where she was declared dead.

Autopsy results showed no drugs in her system.

Brown had gone through a rough patch in life in the year leading up to her death: One home was destroyed by a tornado, she lost her job and then her second home was condemned. She was left homeless, and unable to care for her two children who were taken in by her mother.(State child protective services were supervising the children, and wouldn’t allow Brown to live in the home with them).

Brown passed required drug tests, but results of a screen for mental or behavioral illnesses was inconclusive. She resisted a court-ordered psychological evaluation because, according to her caseworker, she didn’t understand how it differed from the other tests she had undergone.

It’s debatable if Brown, homeless and seemingly mentally unstable was simply pigeon-holed as yet another drug-seeking scam artist in the ER. For it’s part, St. Mary’s says a review of her medical records indicates that it did everything correctly in terms of trying to diagnose and treat her and that is simply a case of a missed diagnosis.

Brown’s family is less certain. They’ve hired a lawyer to investigate the matter, but as of yet have not filed suit. The family feels strongly that Brown’s complaints were not taken seriously by at least some of the health care professionals who treated her. Her sister, Krystle Brown said in a statement to the local media: “My sister is not here today because people passed judgment.”

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A Texas nurse was sentenced to life in prison after being found guilty of killing five of her patients with bleach injections.

Kimberly Saenz, a former nurse at a dialysis clinic in Lufkin, Texas, was convicted on five capital murder charges. She was also sentenced to three 20-year terms for aggravated assault related to other patients who were injured in similar attacks.

Saenz’s attorney had argued during the trial that the deaths were the result of chronic problems with improper cleaning of equipment at the clinic, and that Saenz was being used as a scapegoat.

Jurors deliberated for 45 minutes before agreeing on a sentence. Saenz’s lawyer claimed that the jurors opted for a life sentence instead of the death penalty at least in part because prosecutors failed to show that she was at any risk of committing future violence. He pointed to the fact that she had “behaved” in the past four years since the deaths as evidence that she was not a threat.

Prosecutors had said earlier that they would seek the death penalty, but didn’t specifically call for it during the sentencing phase. However the prosecution did make a point of reminding jurors that she had a history of stealing drugs from previous employers and had faked the results of some of her employment drug tests.

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Williams and a friend are charged with third-degree invasion of privacy and third-degree conspiracy in a case that takes tastelessness to a new low. Prosecutors claim that Williams photographed the genitals of one of her elderly patients and sent the picture to her friend Michele Walker — and Walker promptly posted it on her Facebook page.

Williams has since been fired.

Need for more training? Or better training?

This isn’t the first time health care workers have taken to social media to discuss patients — and sadly, it won’t be the last.

It’s human nature for people to want to talk about the weird, irritating and funny things that they encounter on the job — and health care workers aren’t immune to that. But HIPAA regulations, not to mention basic human decency, require health care pros show a little more tact when discussing a typical day on the job.

Hospitals and medical practices already take great pains to hammer home the importance of maintaining patient privacy and the dangers of social media in a health care setting. Indeed, some hospitals have taken draconian measures. Yet the problem of patient info getting posted on social media sites — or just shared through various and ubiquitous PDAs — continues.

What’s do you think the solution is? More training — or different? Hiring people who are more respectful in the first place? Share your thoughts in the comments.

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Ani Chopourian, a physician’s assistant, worked at Mercy General Hospital in Sacramento, California for about two years, until she was fired in 2008. Chopourian was part of the cardiac surgery unit.

She claimed in her suit that over the years she had filed numerous complaints with human resources regarding a variety of problems, such as a lack of breaks for the PA staff and a demeaning atmosphere for female staffers in general. Chopourian said she was singled out with derisive comments made about her ethnic background, and was repeatedly grabbed — sometimes in front of supervisors who laughed when she asked them for help. Among her claims, Chopourian said one surgeon in particular would greet her daily by slapping her butt and telling her, “I’m horny.”

Chopourian was eventually fired after the hospital said she failed to show up for work one day, and claimed she had been a problematic employee for some time. (Chopourian says she was on call that day, but never notified she was needed at the hospital.)

After the firing, Chopourian filed her suit against the hospital, claiming it created a hostile work environment and fired her to shut her up. Since then, she’s been unable to find other work.

Mercy Hospital management claimed during the trial that the only person who acted unprofessionally at Mercy was Chopourian — but the jurors didn’t buy it. She was awarded a whopping $168 million in damages — the largest finding ever for a single employee in a sexual harassment case. The jury awarded nearly $43 million for lost wages and mental anguish, and another $125 in punitive damages.

The hospital says it’ll appeal the judgment.

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Frisco Medical Center in Frisco, Texas, filed a suit against Cynthia Bledsoe and her new employer Forest Park Medical Center. The suit alleges that around the time of her resignation, Bledsoe used cloud storage services to upload files owned by the hospital.

The stolen files include training packets, strategic business plans, peer reviews and a file that appears to be protected patient information.

Frisco Medical Center says it discovered the alleged theft after hiring a forensic IT service to examine Bledsoe’s computer a few weeks after she tendered her resignation.

Bledsoe had worked for Frisco for 10 years in various positions. She had been promoted to chief operating officer in September of last year. She accepted a job offer from local competitor Forest Park Medical Center in October, and turned in her resignation on Nov. 1.

Frisco accuses Bledsoe of violating a number of laws, as well as breach of contract, breach of duty and breach of fiduciary duty. Frisco is seeking a restraining order and a permanent injunction against Bledsoe, as well as financial damages, interest and attorney’s fees.

So far, no comment from Bledsoe or Forest Park about the matter.

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A nurse is accused of killing five of her patients by injecting bleach into their dialysis tubes. Kimberly Saenz is on trial for capital murder charges in the five deaths. Saenz pleaded not guilty. If she’s convicted, prosecutors have said they will seek the death penalty.

At the time of the deaths, Saenz had been working as an entry-level vocational nurse at DaVita Dialysis in Lufkin, Texas.

The charges were filed about a year after a local fire official wrote an anonymous letter to the state health department. In the April 2008 letter, the official raised a red flag over a series of suspicious incidents at the clinic which resulted in paramedics being called to the scene.

Among other things, the letter detailed a two-week period in which 16 patients had to be transported by ambulance from the clinic.

Within days, investigators were at the clinic — and discovered that paramedics had been called to the clinic 30 times that month. Nineteen people had to be transported to the hospital (seven of them with cardiac complaints) — and four people had died after treatment at the clinic. For reference, in the previous 15 months, ambulance crews had been called only twice.

On April 28, 2008, inspectors were on-site when two patients were stricken ill — and others said they had witnessed Saenz inject bleach into dialysis tubes being used by two patients. Saenz was sent home, the local police were called and the clinic was shut down. The two patients later died.

Subsequent investigation found traces of bleach in various equipment used to treat some of the patients who got sick or died. DaVita had used bleach in various concentrations to clean both internal machinery parts and chairs used by patients. Staffers were supposed to use reactive agents to confirm that any bleach residue had been removed and that the cleaned items were safe for patient use.

More details into the investigation are hard to come by — the court’s put a gag order on all parties involved. But Saenz’s lawyers have noted previously that their client has no criminal record and no apparent motive for trying to kill her patients. Her lawyers have suggested that the clinic was sloppy about its disinfectant procedures and that she’s being used as a scapegoated for systemic problems.

However, prosecutors paint Saenz’s history in less generous terms, noting a history of prescription painkiller abuse, addiction, and having been fired from four prior health care jobs. Prosecutors say she also lied on a more recent employment application, in violation of her bail agreement.

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