Kaiser accuses California ex-employee of embezzling $7 million

http://www.latimes.com/business/la-fi-kaiser-embezzling-20160711-snap-story.html?utm_campaign=KHN%3A+First+Edition&utm_source=hs_email&utm_medium=email&utm_content=31540667&_hsenc=p2ANqtz-9I1Lf0kh4VxReez7DQie-7-_DAWq4kcCNyN4g1i050v34c-SFnUAiO5l7SllcW7_0DnMjKGEIcPGM8fHZ8E47NeCvnaQ&_hsmi=31540667

Dollars

A subsidiary of healthcare giant Kaiser Permanente has filed a lawsuit in California accusing a former employee responsible for investigating insurance fraud claims of embezzling $7 million.

The suit by Kaiser Foundation Health Plan accuses Michael Albert Quinn of submitting invoices for investigative services that were not performed or were not justified over a 16-year span after he joined the company in 1998.

Quinn, 45, worked in Oakland and was responsible for hiring investigators to conduct surveillance on people who were suspected of filing fraudulent claims, the suit says. It says he was authorized to approve charges of as much as $50,000.

Opponents sue to stop California’s vaccination law

http://www.latimes.com/local/lanow/la-me-ln-vaccination-lawsuit-20160705-snap-story.html?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=31347334&_hsenc=p2ANqtz-_6oro_Q46p_yWI2DfGbnrr1dTmzfx12Wlfo5khqsSzd7E0B7adBqUY1BjvdhzW_kZag9xJr1daAoMO9elIYmAbp3q_4A&_hsmi=31347334

vaccine protest

 

Appeals Panels Affirm Injunction Against Fixed Indemnity Regulation, Turn Back Challenge To ‘Administrative Fix’

http://healthaffairs.org/blog/2016/07/03/appeals-panels-affirm-injunction-against-fixed-indemnity-regulation-turn-back-challenge-to-administrative-fix/

Tim-ACA-slide

On July 1, the D.C. Circuit decided two appeals challenging aspects of the implementation of the Affordable Care Act, accepting one challenge and rejecting the other. In Central United Life v. Burwell, a three-judge panel of the D.C. Circuit Court of Appeals affirmed a lower court injunction against a 2014 HHS regulatory prohibition on the sale of fixed indemnity insurance unless the purchaser attests that he or she already has minimum essential coverage. And in West Virginia v. HHS, a different panel of the D.C. Circuit rejected a challenge brought by the state of West Virginia to the “administrative fix” announced by HHS late in 2013. Under this arrangement, HHS deferred for 2014 enforcement of eight of the ACA’s insurance market reform requirements against existing insurance plans in the individual and small group market.

GA, CA Hospitals Sue Blue Cross Plan for Sending ER Reimbursements To Patients

http://www.healthleadersmedia.com/finance/ga-ca-hospitals-sue-blue-cross-plan-sending-er-reimbursements-patients?spMailingID=9138342&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=942934540&spReportId=OTQyOTM0NTQwS0

Hospital Lawsuit

That’s costing the hospitals money since patients don’t always turn over the funds, according to the lawsuits, filed by Polk Medical Center in northwest Georgia and Martin Luther King, Jr. Community Hospital in Los Angeles.

Judge sides with hospitals over California ballot initiative to cap executive pay

http://www.mercurynews.com/elections/ci_30057620/judge-sides-hospitals-over-california-ballot-initiative-cap

Executive Compensation

 

Transgender nurse sues Dignity Health for refusing to cover gender reassignment costs

http://www.beckershospitalreview.com/legal-regulatory-issues/transgender-nurse-sues-dignity-health-for-refusing-to-cover-gender-reassignment-costs.html

Lawsuit2

Specifically, the lawsuit alleges Dignity’s policy violates regulations released by HHS last month that prohibit healthcare companies that receive federal aid from denying coverage to plan members for health services related to gender transformation.

Chicago hospital accused of illegally transferring pension obligations to an order of nuns

http://www.beckershospitalreview.com/legal-regulatory-issues/chicago-hospital-accused-of-illegally-transferring-pension-obligations-to-an-order-of-nuns.html

Pressure-on-hospital-pension-plans

Holy Cross is one of many healthcare organizations across the nation accused of misclassifying pension plans as church plans. According to Bloomberg BNA, 30 similar lawsuits have been brought against religiously affiliated healthcare companies over the past three years. In May, Hartford, Conn.-based St. Francis Hospital, part of Livonia, Mich.-based Trinity Health, agreed to pay $107 million to settle a lawsuit alleging it mismanaged its pension plan by classifying it as a church plan.

Trinity Health hospital to pay $107M to settle pension mismanagement lawsuit

http://www.beckershospitalreview.com/legal-regulatory-issues/trinity-health-hospital-to-pay-107m-to-settle-pension-mismanagement-lawsuit.html

Pension

The $107 million settlement is more than 13 times larger than the $8 million settlement reached by St. Louis-based Ascension Health and its workers in a similar suit in 2015. In their suit against Ascension, workers claimed the system’s pension plans were underfunded by more than $444.5 million. The St. Francis and Ascension Health cases are the only two public settlements that have been reached in the 30 class-action suits filed in the past three years accusing religiously affiliated hospitals of mismanaging their pensions, according to the report.

Hospitals claim the ACA demands mergers: Are judges warming up to the argument?

http://www.beckershospitalreview.com/legal-regulatory-issues/hospitals-claim-the-aca-demands-mergers-are-judges-warming-up-to-the-argument.html

Healthcare Law

Judges have largely dismissed the argument that hospitals need to merge to meet the demands of the Affordable Care Act, but a Pennsylvania judge recently accepted the “Obamacare-made-me-do-it” defense, according to the National Law Review. In defense to an antitrust challenge by the FTC, plenty of hospitals have argued mergers are necessary to meet ACA goals, such as moving away from the fee-for-service model and providing high quality care more efficiently.

ACEP files federal lawsuit over out-of-network underpayments

http://www.healthcaredive.com/news/acep-files-federal-lawsuit-over-out-of-network-underpayments/419465/

The American College of Emergency Physicians has filed suit against HHS over a provision in the Affordable Care Act health law they say lets insurers get away with underpayments for out-of-network emergency care, Modern Healthcare reported.