7 latest healthcare industry lawsuits, settlements

https://www.beckershospitalreview.com/legal-regulatory-issues/7-latest-healthcare-industry-lawsuits-settlements-100518.html?origin=cfoe&utm_source=cfoe

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From the U.S. Equal Employment Opportunity Commission suing a Tennessee health system over its flu shot policy to a Montana health system paying $24 million to settle a whistle-blower lawsuit, here are the latest healthcare industry lawsuits and settlements making headlines.

1. EEOC sues Saint Thomas Health over mandatory flu shot policy
The U.S. Equal Employment Opportunity Commission filed a lawsuit against Nashville, Tenn.-based Saint Thomas Health Sept. 28, alleging Murfreesboro, Tenn.-based Saint Thomas Rutherford Hospital violated federal law by ordering an employee to receive a flu shot despite his religious belief

2. Montana hospital pays $24M to settle ex-CFO’s whistle-blower suit
Kalispell (Mont.) Regional Healthcare System and six subsidiaries and related entities agreed to pay the federal government $24 million to resolve allegations they violated the False Claims Act, Stark Law and the Anti-Kickback Statute.

3. DaVita resolves false claims, whistle-blower allegations for $270M
HealthCare Partners Holdings, which does business as DaVita Medical Holdings, will pay $270 million to settle False Claims Act violations and a whistle-blower lawsuit.

4. AmerisourceBergen to pay $625M to settle civil fraud charges linked to repackaging scandal
Drug wholesaler AmerisourceBergen will pay $625 million to resolve allegations that the company improperly distributed tampered and repackaged drugs.

5. Kansas physician awarded $29M in wrongful termination suit
A jury awarded a Kansas emergency physician $29 million for his lawsuit claiming he was wrongfully terminated by the emergency room staffing company he worked for after voicing concerns about the organization’s business practic

6. Disability advocacy firm sues Arizona hospital over access to patients
The Arizona Center for Disability Law filed a lawsuit Sept. 12 against Phoenix-based Arizona State Hospital, claiming hospital officials violated federal law by refusing to provide the center with access to the facility, patients and their records.

7. Louisiana health system stuck in antitrust suit brought by ex-hospital operator, health plan
BRF, a hospital operator in Shreveport, La., and the regional Vantage Health Plan are surging forward with an antitrust lawsuit against Shreveport-based Willis-Knighton Health System, even though BRF left the hospital business Oct. 1.

 

Aetna whistle-blower put on leave after accusing CVS Caremark of $1B billing scheme

https://www.beckershospitalreview.com/legal-regulatory-issues/aetna-whistle-blower-put-on-leave-after-accusing-cvs-caremark-of-1b-billing-scheme.html

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Aenta’s former chief Medicare actuary was placed on administrative leave after filing a whistle-blower lawsuit alleging pharmacy benefits manager CVS Caremark overbilled Medicaid and Medicare for prescription drugs, according to The Columbus Dispatch.

Here are four things to know about the lawsuit.

1. Sarah Behnke, Aetna’s former chief Medicare actuary, filed the pending whistle-blower suit after her internal investigation found CVS Caremark has been allegedly overbilling the federal government for prescriptions since 2007, according to the lawsuit. Ms. Behnke accused CVS Caremark of inappropriately billing the government $1 billion-plus in fraudulent charges.

2. Aetna placed Ms. Behnke on administrative leave after the whistle-blower suit was unsealed in federal court in early April. The unsealing comes as CVS Health, the parent company of CVS Caremark, is attempting to buy Aetna for $69 billion.

3. Ms. Behnke’s lawyer told The Columbus Dispatch Aetna’s decision to place its then-Medicare actuary on administrative leave was “retaliatory and inappropriate.”

4. CVS Caremark rejected the allegations and said it will hand documents over to the court by June 1. The company said it was unaware who filed the lawsuit until after its parent put out an offer to Aetna. CVS Health spokesperson Michael DeAngelis told the publication, “We believe this complaint is without merit, and we intend to vigorously defend ourselves against these allegations.” Aetna officials declined The Columbus Dispatch‘s request for comment.

 

TeamHealth to pay $60 million to settle ‘upcoding’ claims as acquisition by Blackstone wraps up

http://www.healthcarefinancenews.com/news/teamhealth-pay-60-million-settle-upcoding-claims-acquisition-blackstone-wraps?mkt_tok=eyJpIjoiWmpKaE5ETXhZVGc0TkdJNSIsInQiOiJjWXBGUGRYOWwySVVDRnRsdjhpOTJEK09yNSt1dzcyN1d0TmNucCtzN1A4cWlVcGl2NmM3M1wvR0lYQjRUa3ZQdzd2b2g4ZnFQWFRlYVhBMFwvY3I2VFlJaEVkdXhlODhNSGk4VUpVempaVUloZVBmRjRtekZXQ1ZGYVdjNFRJdkZRIn0%3D

DOJ alleged that subsidiary IPC pressured physicians to bill for higher levels of service than what was provided.

TeamHealth Holdings, nationwide hospital staffing provider and owner of group practice IPC Healthcare, has agreed to pay $60 million plus interest to settle allegations that IPC engaged in a prolonged scheme of billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for more expensive medical services that were actually provided, the Department of Justice announced.

TeamHealth is comprised of more than 20,000 affiliated physicians and advanced practice clinicians, and offers outsourced emergency medicine, hospital medicine, critical care, anesthesiology, orthopedic hospitalist, acute care surgery, obstetrics and gynecology hospitalist, and other services to approximately 3,300 acute and post-acute facilities and physician groups across the country.

According to the DOJ, the government alleged that IPC put corporate pressure on physicians to “upcode” claims to maximize billing, especially pressuring physicians with lower billing levels.

TeamHealth also agreed to increase accountability and transparency in order to avoid any future fraud, according to the settlement.

The allegations stem from a whistleblower lawsuit filed in a Chicago federal court by Bijan Oughatiyan, a physician formerly employed by IPC as a hospitalist. Under the False Claims Act, the government was allowed to intervene and take over the suit, as it did in this case. Oughatiyan will receive about $11.4 million, which is his share of the recovery as allowed under the False Claims Act.

The acquisition of TeamHealth by funds affiliated with global asset manager Blackstone and certain other investors, wrapped up Monday, making TeamHealth a privately held company.

Biggest healthcare frauds in 2016: Running list

http://www.healthcarefinancenews.com/slideshow/biggest-healthcare-frauds-2016-running-list?mkt_tok=eyJpIjoiWVRrMVl6UmtNek5qTURkaSIsInQiOiJ0Q2t5WUwzMm1TMDZaM0NrVU53eWtLWXIrb2tNUDBRZWhpNHRBb3VqWWh0blIzNUR2S1BlSVwveGFCTG9EYStDTFNTWjIrXC9LMmR4YU1DYXU3NVY1QUNoNUxDOW5zWVJVcjdvcFU2TW9vOU04PSJ9

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Warner Chilcott to pay $125 million over kickback scheme, former drug company officials indicted

http://www.healthcarefinancenews.com/news/warner-chilcott-pay-125-million-over-kickback-scheme-former-drug-company-officials-indicted?mkt_tok=3RkMMJWWfF9wsRovuKnPZKXonjHpfsX57u4rUa6zlMI%2F0ER3fOvrPUfGjI4ATMNkMa%2BTFAwTG5toziV8R7nHLs161sIQWRjg

Whistleblowers net $22.9 million for exposing drug company’s fraud.

DOJ reaches $250M settlement with 457 hospitals to resolve Medicare billing dispute

http://www.healthcaredive.com/news/doj-reaches-250m-settlement-with-457-hospitals-to-resolve-medicare-billing/408340/

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504 hospitals hit with whistle-blower lawsuit alleging false claims violations

http://www.beckershospitalreview.com/legal-regulatory-issues/504-hospitals-hit-with-whistle-blower-lawsuit-alleging-false-claims-violations.html

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Adventist Health System to pay $115 million to settle suit over false claims

http://www.healthcarefinancenews.com/news/adventist-health-system-pay-115-million-settle-suit-over-false-claims?mkt_tok=3RkMMJWWfF9wsRouv6TIZKXonjHpfsX57u4rUa6zlMI%2F0ER3fOvrPUfGjI4ITcBkI%2BSLDwEYGJlv6SgFQ7LHMbpszbgPUhM%3D

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The settlement is one of the largest of its kind, representing a continued crackdown by federal authorities.