Tag Archives: Lawsuit

The feds have been ordered to cough up risk corridor money.

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The feds have been ordered to cough up risk corridor money.

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A judge on the Court of Federal Claims has entered a $214 million judgment against the United States in favor of Moda Health, an Oregon insurer. Moda sued to recover money owed to it under the risk corridor program, a three-year program that was supposed to protect insurers from excessive losses on the exchanges. In emphatic language, the court ordered the government to pay up.

The Court finds that the ACA requires annual payments to insurers, and that Congress did not design the risk corridors program to be budget-neutral. The Government is therefore liable for Moda’s full risk corridors payments under the ACA. In the alternative, the Court finds that the ACA constituted an offer for a unilateral contract, and Moda accepted this offer by offering qualified health plans on the [exchanges]. …

Today, the Court directs the Government to fulfill [its] promise. After all, “to say to [Moda], ‘The joke is on you. You shouldn’t have trusted us,’ is hardly worthy of our great government.” Brandt v. Hickel, 427 F.2d 53, 57 (9th Cir. 1970).

http://www.nejm.org/doi/full/10.1056/NEJMp1612486#t=article

 

DOJ charges ex-Tenet Healthcare exec with role in $400M fraud scheme

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http://www.fiercehealthcare.com/healthcare/doj-charges-ex-tenet-healthcare-exec-role-400m-fraud-scheme

DOJ

Six months after Tenet Healthcare reached an agreement to pay $514 million in penalties for an alleged kickback scheme, one of its former executives has been indicted for his part in the plan to pay bribes for patient referrals.

The Department of Justice announced Wednesday that it has indicted John Holland, 60, of Dallas in his role in a $400 million scheme to defraud the government, Georgia and South Carolina Medicaid Programs, and prospective patients of Tenet hospitals.

Holland, the former senior vice president of operations for Tenet Healthcare Corporation’s Southern States Region and the former chief executive officer of North Fulton Medical Center Inc. in Roswell, Georgia, was charged with mail fraud, healthcare fraud and major fraud against the United States.

The indictment alleges Holland was involved in a scheme to pay bribes for patient referrals. which helped Tenet bill the Georgia and South Carolina Medicaid Programs more than $400 million and obtain more than $149 million in Medicaid and Medicare payments based on those patient referrals.

The scheme began in 2000, according to the indictment,  when Holland circumvented internal accounting controls and falsified Tenet’s books, records and reports to conceal payments of bribes and kickbacks in return for the referral of patients to North Fulton Medical Center Inc. and other Tenet hospitals, including Atlanta Medical Center Inc., Spalding Regional Medical Center Inc. and Hilton Head Hospital.

Holland pled not guilty to the charges during a court hearing, Reuters reported. His lawyer, Richard Deane, said Tenet’s agreement in August to settle criminal charges and civil claims, should have resolved this issue.

“Mr. Holland is not guilty and we now look forward to presenting this case to a jury,” Deane said in a statement to Reuters.

But Acting Assistant Attorney General Blanco said in a statement from the DOJ that “these charges underscore our continued commitment to holding both individuals and corporations accountable for their fraudulent conduct.“We will follow the evidence where it takes us, including to the corporate executive ranks.”

Drug Makers Accused of Fixing Prices on Insulin

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A lawsuit filed Monday accused three makers of insulin of conspiring to drive up the prices of their lifesaving drugs, harming patients who were being asked to pay for a growing share of their drug bills.

The price of insulin has skyrocketed in recent years, with the three manufacturers — Sanofi, Novo Nordisk and Eli Lilly — raising the list prices of their products in near lock step, prompting outcry from patient groups and doctors who have pointed out that the rising prices appear to have little to do with increased production costs.

The lawsuit, filed in federal court in Massachusetts, accuses the companies of exploiting the country’s opaque drug-pricing system in a way that benefits themselves and the intermediaries known as pharmacy benefit managers. It cites several examples of patients with diabetes who, unable to afford their insulin treatments, which can cost up to $900 a month, have resorted to injecting themselves with expired insulin or starving themselves to control their blood sugar. Some patients, the lawsuit said, intentionally allowed themselves to slip into diabetic ketoacidosis — a blood syndrome that can be fatal — to get insulin from hospital emergency rooms.

A recent study in The Journal of the American Medical Association found that the price of insulin nearly tripled from 2002 to 2013.

“People who have to pay out of pocket for insulin are paying enormous prices when they shouldn’t be,” said Steve Berman, a lawyer whose firm filed the suit on behalf of patients and is seeking to have it certified as a class action.

In a statement, Sanofi said, “We strongly believe these allegations have no merit, and will defend against these claims.” Lilly said it had followed all laws, adding, “We adhere to the highest ethical standards.”

A spokesman for Novo Nordisk said the company disagreed with the allegations in the suit and would defend itself. “At Novo Nordisk,” the company’s statement said, “we have a longstanding commitment to supporting patients’ access to our medicines.”

The rising costs of drugs has led to several hearings in Congress and has drawn the attention of President Trump, who this month pledged to address the issue and said the industry was “getting away with murder.”

 

Trump’s path on health care law intersects with a lawsuit

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http://www.seattletimes.com/business/trumps-path-on-health-care-law-intersects-with-a-lawsuit/

FILE – In this Oct. 24, 2016, file photo, the HealthCare.gov 2017 web site home page as seen in Washington. (AP Photo/Pablo Martinez Monsivais, File)

President-elect Donald Trump says he wants to preserve health insurance coverage even as he pursues repeal of the Obama-era overhaul that provided it to millions of uninsured people.

How his administration handles a pending lawsuit over billions of dollars in insurance subsidies will reveal whether Trump wants an orderly transition to a Republican-designed system or if he’d push “Obamacare” over a cliff. Stripping away the subsidies at issue in the case would put the program into a free-fall.

The question in the House v. Burwell case couldn’t be more technical: whether the Affordable Care Act specifically states in its hundreds of pages that the government can pay money to help reduce out-of-pocket costs for low-income consumers on HealthCare.gov and state insurance markets.

Those subsidies for deductibles and copayments are paid directly to insurers, on top of the law’s tax credits that reduce premiums for consumers. Since the ACA’s basic coverage is fairly skimpy, the cost-sharing subsidies make it work for millions of people when they seek treatment. For example, subsidies can bring a $1,500 hospital copayment down to $100.

House Republicans have taken the Obama administration to court. They argue that the law lacks a specific congressional “appropriation” for the subsidies, estimated to total $9 billion next year. A federal district judge in Washington, D.C., agreed with the House and the case is now on appeal.

What’s going to happen with House v. Burwell?

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What’s going to happen with House v. Burwell?

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I’m getting a lot of head-scratching questions about the lawsuit, which is now pending at the D.C. Circuit. Let me see if I can help.

As I see it, there are two distinct questions in play:

  1. Does President Trump want to stop making cost-sharing payments on Day One, leading to the immediate collapse of the individual insurance market in many states? Or does he want to keep making the payments during a transition period?
  2. What approach will the Trump administration take to the litigation?

Walgreens just filed a $140 million lawsuit against Theranos

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http://www.businessinsider.com/walgreens-files-lawsuit-against-theranos-2016-11?nr_email_referer=1&utm_source=Sailthru&utm_medium=email&utm_content=ScienceSelect&pt=385758&ct=Sailthru_BI_Newsletters&mt=8&utm_campaign=BI%20Science%202016-11-08&utm_term=Science%20Select%20-%20Engaged%2C%20Active%2C%20Passive%2C%20Disengaged

Elizabeth Holmes

Walgreens has filed a breach of contract lawsuit against Theranos, the embattled blood-testing startup.

The lawsuit was filed Tuesday in Delaware’s district court. Details on Walgreen’s complaint weren’t immediately available because the suit was sealed by the court.

The Wall Street Journal is reporting that Walgreens is looking for $140 million in damages, claiming that Theranos misled Walgreens about how far along its blood-testing technology was when the original partnership was inked.

Walgreens, once Theranos’ biggest partner, terminated its relationship with the company in June. It had operated Theranos Wellness Centers, where people could go have their blood tested in the company’s stores.

DOJ says Aetna, Humana are trying to derail antitrust case

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http://www.bizjournals.com/louisville/news/2016/10/11/doj-says-aetna-humana-are-trying-to-derail.html

Lawyers for the U.S. Department of Justice say Aetna Inc. and Humana Inc are trying to derail the government's antitrust challenge of Aetna's proposed $37 billion acquisition of Humana.

Lawyers for the U.S. Department of Justice say Aetna Inc. and Humana Inc are trying to derail the government’s antitrust challenge of Aetna’s proposed $37 billion acquisition of Louisville-based Humana.

This comes after lawyers for the companies accused the DOJ with “serious delay and misconduct” last week. The companies requested sanctions, claiming that the government withheld about 1 million documents and that this had “gravely undermined” the companies’ ability to mount a defense against claims that the acquisition would hurt competition.

The National Law Journal reports that the government’s response came Saturday in a court filing, in which it said the DOJ has tried to accommodate the “broad and extremely burdensome discovery demand” from Aetna (NYSE: AET) and Humana (NYSE: HUM) on the U.S. Department of Health and Human Services.

The government called the request for sanctions “a transparent attempt to derail the United States’ merger challenge before the district court ever hears from a single witness or reviews any evidence,” the law journal reported.

At issue is how much market share the combined company would control in Medicare Advantage, a type of Medicare plan offered by a private insurer. A court date is set for Dec. 5, 2016, and the judge says a decision isn’t likely until mid-January 2017 — past the companies’ end-of-year deadline to close the deal.

Saint Vincent Hospital sued for firing six employees who refused flu shots

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http://www.beckershospitalreview.com/legal-regulatory-issues/saint-vincent-hospital-sued-for-firing-six-employees-who-refused-flu-shots.html

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The Equal Employment Opportunity Commission is accusing Erie, Pa.-based Saint Vincent Hospital of religious discrimination, reports Erie Times-News.

The commission filed a lawsuit Thursday in U.S. District Court in Erie, alleging Saint Vincent fired six employees who refused to get flu shots due to their religious beliefs, according to the article. At the same time, the group contends, the hospital granted medical exemptions to 14 other employees in late 2013 and early 2014, according to the article.

The commission claims the hospital violated Title VII of the Civil Rights Act of 1964.

Saint Vincent officials said in a statement obtained by Erie Times-News that the hospital’s “mandatory flu vaccination policy allows employees to apply for an exemption to the policy based upon religious beliefs or health concerns. Requests for exemption are always given careful and appropriate consideration. We respectfully disagree with the (commission’s) position and characterization of how the employee claims outlined in this lawsuit were handled by the hospital.”

According to the report, the commission previously attempted to reach a settlement with Saint Vincent, which is now part of Pittsburgh-based Allegheny Health Network.

12 latest healthcare industry lawsuits, settlements

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

Dollars and Stethescope2

 

Calif. hospital to pay 3 former employees $1.7M in harassment suit

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http://www.beckershospitalreview.com/legal-regulatory-issues/calif-hospital-to-pay-3-former-employees-1-7m-in-harassment-suit.html

Community Hospital of Long Beach (Calif.) and the former manager of the hospital’s psychiatric unit have been ordered to pay $1.7 million to three ex-employees who alleged they were subjected to sexual harassment and discrimination, according to the Long Beach Patch.

The plaintiffs accused Keith Kohl, RN, who directed the hospital’s psychiatric unit and was employed by Memorial Psychiatric Health Services, of discrimination. The female plaintiffs alleged Mr. Kohl flaunted his homosexuality, creating a hostile work environment. They further alleged he gave preferential treatment to gay males.

In their suit, the plaintiffs argued their employment with the hospital was wrongfully terminated, while the hospital claimed they had been fired for putting a patient in restraints without a physician’s orders and lying during an investigation into the incident.

After nearly three hours of deliberation, the jury issued a verdict in favor of the plaintiffs, finding evidence of sexual harassment, discrimination, failure to prevent harassment and discrimination, wrongful termination, defamation and negligent supervision.