Henry Ford Allegiance ‘Reluctantly’ Settles DOJ Antitrust Suit

http://www.healthleadersmedia.com/marketing/henry-ford-allegiance-reluctantly-settles-doj-antitrust-suit?utm_source=edit&utm_medium=ENL&utm_campaign=HLM-Daily-SilverPop_02142018&spMailingID=12931448&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1341286596&spReportId=MTM0MTI4NjU5NgS2

Image result for lawsuit settlement

The Jackson, Michigan–based health system agrees to stop coordinated anti-competitive business activities with competitors, but insists that it did nothing wrong.

Henry Ford Allegiance Health has settled its three-year antitrust fight with state and federal prosecutors, just weeks before the case was set for trial in federal court.

The Department of Justice and the Michigan Attorney General’s office filed suit in 2015, alleging that Henry Ford Allegiance Health and three other health systems in south central Michigan carved up the territory and insulated themselves from competition by agreeing to withhold outreach and marketing in each other’s respective counties.

The three other health systems, Hillsdale Community Health Center; Community Health Center of Branch County in Coldwater; and ProMedica Health System in Toledo, OH, settled their suits two years ago.

“As a result of Allegiance’s per se illegal agreement to restrict marketing of competing services in Hillsdale County, Michigan consumers were deprived of valuable services and healthcare information,” Assistant Attorney General Makan Delrahim in DOJ’s Antitrust Division said in a media release. “By prohibiting further anticompetitive conduct and educating Allegiance executives on antitrust law, this settlement will ensure that consumers receive the fruits of robust competition.”

The proposed settlement was filed Friday in U.S. District Court for the Eastern District of Michigan, where the case was scheduled to go to trial on March 6.

Allegiance said in prepared remarks that it felt compelled to settle even though it did nothing wrong.

“We reluctantly chose to settle this litigation because continuing to defend ourselves against the United States and State of Michigan became too costly,” the health system said. “This decision, regrettable but necessary, requires us to discontinue our defense of this case before the Court could rule on any of the highly contested issues raised in the litigation.”

DOJ’s settlement with Allegiance expands on the earlier settlements with the other three health systems, which means that Allegiance cannot communicate, coordinate or limit marketing or business development with competitors. The agreement ends the health system’s carve out in Hillsdale County. Allegiance must also file annual compliance reports and submit to compliance inspections, and reimburse state and federal prosecutors for the court costs.

DOJ said the deal includes several new provisions that are now included in all new consent decrees that add greater specificity and accountability.

“The proposed settlement will make it easier and more efficient for the department to enforce the decree by allowing the department to prove alleged violations by a preponderance of the evidence,” Delrahim said. “These provisions will encourage a stronger commitment to compliance and will ease the strain on the department in investigating and enforcing possible violations.”

Patricia Wagner, an antitrust attorney with Epstein Becker Green and a disinterested observer, said DOJ is applying more rigorous benchmarks for its consent decrees.

“When you do your annual report you have to document that everybody got their four hours of training and you have to provide the materials that were used in those training sessions. If DOJ asks, you’d have to provide a lot of who had what conversations, and when,” Wagner said. “Instead of just having a general ‘you will comply with this consent order and verify annually that you are doing so,’ it is giving organizations the steps that DOJ thinks they need to take in order to comply with the consent judgements.”

“If I am a CEO of a hospital maybe I am thinking about how to get ahead of this situation. Should I have someone who is responsible for antitrust compliance?” she said. “All hospitals have large compliance programs that are usually focused, as they should be, on fraud and abuse and licensure issues. It seems like a natural evolution to say ‘maybe we should be thinking about including antitrust in that larger compliance program.'”

Henry Ford Allegiance Health operates the only hospital in Jackson County, MI. The system also operates primary care, physical rehabilitation, and diagnostic facilities in several counties in south central Michigan. Allegiance joined Henry Ford Health System in 2016.

Allegiance’s statement in full reads as follows:

Allegiance Health and the Department of Justice have settled an antitrust case brought by the DOJ against Allegiance Health in 2015. The original complaint alleged that Allegiance Health entered into an agreement with Hillsdale Community Health Center to limit marketing in Hillsdale County.

We reluctantly chose to settle this litigation because continuing to defend ourselves against the United States and State of Michigan became too costly. This decision, regrettable but necessary, requires us to discontinue our defense of this case before the Court could rule on any of the highly contested issues raised in the litigation. 

We still deny unlawful conduct of any kind, and the settlement does not include any admission of liability. Despite almost three years of litigation, there was no finding of wrong doing by the Court, and, as recently as December, the Court contemplated dismissing the action in its entirety.  In addition, the Court has never ruled that the citizens of Hillsdale County were harmed by our marketing strategy.

We reaffirm our belief that we promoted competition in south central Michigan and benefitted the citizens of Hillsdale County in undeniable ways. The terms of the settlement allow us to continue our marketing strategies in order to best serve the people of south central Michigan including Hillsdale County.

 

 

Federal judge approves Ascension Health’s $29.5M settlement in class-action pension lawsuit

https://www.beckershospitalreview.com/legal-regulatory-issues/federal-judge-approves-ascension-health-s-29-5m-settlement-in-class-action-pension-lawsuit.html

Image result for ascension health lawsuit

 

Ascension Health, a Catholic health system based in St. Louis, will pay $29.5 million to settle a class-action lawsuit alleging the health system and subsidiary Wheaton Franciscan Services in Glendale, Wis., violated the Employee Retirement Income Security Act, which governs employee pensions.

The lawsuit, filed in April 2016, alleged Wheaton erroneously treated its pension plan as a “church plan” exempt from ERISA.

The parties entered a class-action settlement agreement Sept. 1, 2017, and the court preliminarily approved the settlement Sept. 13, 2017. The court gave final approval to the proposed settlement after holding a fairness hearing on Jan. 16.

The parties inked the settlement agreement about three months after the U.S. Supreme Court held church-affiliated hospitals do not have to comply with ERISA.

https://www.beckershospitalreview.com/legal-regulatory-issues/supreme-court-exempts-church-affiliated-hospitals-from-federal-pension-law-5-things-to-know.html

 

Ascension to pay $29.5M settlement in pension lawsuit

http://www.beckershospitalreview.com/legal-regulatory-issues/ascension-to-pay-29-5m-settlement-in-pension-lawsuit.html

Image result for pension lawsuit settlement

St. Louis-based Ascension Health ended a class-action lawsuit filed against the system and subsidiary Wheaton Franciscan Services in Glendale, Wis., alleging Wheaton erroneously treated its pension plan as a “church plan” exempt from the federal Employee Retirement Income Security Act, Bloomberg BNA reports.

Under the settlement, Ascension will pay $29.5 million in benefit payments for Wheaton’s retirement plan and up to $2.25 million in legal fees and expenses. Court papers filed Sept. 1 show the deal mandates Ascension to guarantee payment of the $29.5 million for the benefits if the plan cannot cover the costs, the report states.

Ascension and Wheaton denied the allegations in filed court papers, St. Louis Business Journal reports. The settlement requires court approval before it is finalized.

In June, the U.S. Supreme Court held church-affiliated hospitals are not required to comply with ERISA, which governs employee pensions.

 

EHR vendor, executives to pay $155M for allegedly misrepresenting software’s capabilities

http://www.beckershospitalreview.com/legal-regulatory-issues/ehr-vendor-executives-to-pay-155m-for-allegedly-misrepresenting-software-s-capabilities.html

Image result for whistle blower lawsuit

Westborough, Mass.-based eClinicalWorks, an EHR vendor, and some of its executives and employees have agreed to pay $155 million to resolve allegations it violated the False Claims Act, according to the Department of Justice.

HHS offers incentive payments to healthcare provider organizations that demonstrate meaningful use of certified EHR technology. Companies that develop and market EHR software must attest that their software meets certain criteria adopted by HHS and also pass testing by an HHS-approved entity.

The government alleged eClinicalWorks falsely obtained certification for its EHR software by withholding information from its certifying entity. For example, the company allegedly concealed that its software wasn’t able to meet certain criteria for standardized drug codes. Software must be able to retrieve any drug code from a complete database for certification. Instead of disclosing that its software didn’t meet this requirement, eClinicalWorks allegedly hardcoded only the 16 drug codes required for testing directly into its software.

Due to eClinicalWorks’ alleged misrepresentations, healthcare organizations using the company’s software submitted false claims for federal incentive payments, according to the DOJ.

The government also alleged the company paid kickbacks to certain customers in exchange for promoting its product.

Under the settlement agreement, eClinicalWorks and three of its founders — CEO Girish Navani, CMO Rajesh Dharampuriya, MD, and COO Mahesh Navani — will pay $154.92 million to the federal government. A software developer will pay an additional $50,000 and two project managers will each pay $15,000, according to the DOJ.

In addition to the monetary settlement, eClinicalWorks entered into a corporate integrity agreement with HHS’ Office of Inspector General that covers the company’s EHR software.

The allegations against eClinicalWorks were originally brought under the qui tam, or whistle-blower, provisions of the False Claims Act.

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.

Tenet Healthcare to pay $513 million over referral, kickback scheme, DOJ says

http://www.healthcarefinancenews.com/news/tenet-healthcare-pay-513-million-over-referral-kickback-scheme-doj-says?mkt_tok=eyJpIjoiWVRrMVl6UmtNek5qTURkaSIsInQiOiJ0Q2t5WUwzMm1TMDZaM0NrVU53eWtLWXIrb2tNUDBRZWhpNHRBb3VqWWh0blIzNUR2S1BlSVwveGFCTG9EYStDTFNTWjIrXC9LMmR4YU1DYXU3NVY1QUNoNUxDOW5zWVJVcjdvcFU2TW9vOU04PSJ9

Hilton Head Hospital (Photo via Google)

Payout settles allegations of illegal kickbacks paid to clinic owners in exchange for referring patients for labor and delivery to Tenet hospitals.

12 latest healthcare industry lawsuits, settlements

http://www.beckershospitalreview.com/legal-regulatory-issues/12-latest-healthcare-industry-lawsuits-settlements-august28.html

Dollars and Stethescope2

 

13 recent healthcare industry lawsuits, settlements

http://www.beckershospitalreview.com/legal-regulatory-issues/13-recent-healthcare-industry-lawsuits-settlements-july8.html

Money and Scale

SRHS legal showdown ends in $150 million-plus settlement

http://www.sunherald.com/news/special-reports/singing-river-health-system/article81375622.html

TIM ISBELL/SUN HERALD Members of Singing River Health System's pension plan join hands and pray before entering the federal courthouse in Gulfport on Monday, May 16, 2016, for a hearing on a proposed class-action settlement involving their retirement benefits. A federal judge approved the settlement Thursday.

More than 200 feisty retirees wanted to pursue lawsuits against Singing River Health System over its failed pension plan, but U.S. District Court Judge Louis Guirola Jr. has signed off on a settlement proposed by attorneys for other pension-plan members.

Wyeth and Pfizer Agree to Pay $784.6 Million to Resolve Lawsuit Alleging That Wyeth Underpaid Drug Rebates to Medicaid

https://www.justice.gov/opa/pr/wyeth-and-pfizer-agree-pay-7846-million-resolve-lawsuit-alleging-wyeth-underpaid-drug-rebates

DOJ Building

http://www.fiercehealthpayer.com/antifraud/story/pfizer-pays-785-million-resolve-drug-pricing-allegations/2016-05-02?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTWpVd1lqSTNZalZsWWpReCIsInQiOiJINE9BNitVSm1VYUR3NFVOZG1YMFFiVFQ2d2lmRGtEZ01NdjVpY0x2bmZUSmxTVFFcL2NcL3FMTmlGaXJqRFhSUHI2Tm1yK0Q1MHU1R3U2OWlGQ3NVYU9uTll2VXMxcEJSdUxlcGlYSjJEV1ZBPSJ9