In a surprise move, the DOJ has changed its stance on Texas v Azar and is "not urging any portion of the district court's judgement be reversed" but, in Dec. 2018 the agency told the court that while it agreed the individual mandate was not valid it would defend other parts of the Affordable Care Act, just not community rating and...Arizona News
Last week on Oct. 12, 33-year-old Nicholas White and 60-year-old Jeffrey White, father and son duo pleaded guilty to defrauding Affordable Care Act (ACA) programs out of $27 million across at least 12 states--including Arizona. Both were healthcare professionals out of Twin Peaks, California.
According to the Department of Justice...Arizona News
Last week the Department of Justice gave CVS and Aetna approval for their $69 billion merger on the condition that Aetna sells off its Medicare Part D prescription drug business. Insurers cozying up with the pharmaceutical industry is a growing trend, think: OptumRx and UnitedHealth, or the recent Cigna-Express Scripts...National News
The settlement announced October 1 resolves DaVita from False Claims Act liability for providing inaccurate information that caused Medicare Advantage plans to receive inflated Medicare payments.
DaVita voluntarily disclosed to the feds practices instituted by HealthCare Partners, a large California-based independent physician...Arizona News
On Monday the Justice department gave the $52 billion merger between Cigna and Express Scripts a green light. The health insurance giant and massive pharmacy benefits manager aim to cut costs of care.
The deal passed a shareholder vote toward the end of August but the DOJ's vote was the last major obstacle to clear, all that...National News
On Aug. 3, the U.S. Department of Justice reached a settlement with Prime Healthcare and its CEO Dr. Prem Reddy have agreed to pay $65 million to settle allegations of Medicare over-billing for false claims across 14 Prime hospitals in California. A San Diego whistleblower Karin Berntsen, will receive $17.2 million for her reporting of...Arizona News
The $18.3 million settlement agreement released Friday by the Health and Human Services Office of Inspector General, calls for a long list of reforms that Banner must implement then maintain for five years.
Banner's present legal trouble stemmed from a whistleblower complaint filed under the False Claims Act in 2013 by Cecilia...Arizona News
Banner Health has agreed to pay the United States over $18 million to settle allegations that 12 of its hospitals in Arizona and Colorado knowingly submitted false claims to Medicare by admitting patients who could have been treated on a less costly outpatient basis.
The settlement resolves allegations that 12 Banner Health hospitals...National News
Justice Department claimed the insurer obtained more than $1 billion from Medicare based on inaccurate information. Judge disagreed. United counter sues.
Reuters is referenced in a Becker's Hospital Review report. The original False Claims Act lawsuit claimed UnitedHealth received at least $1 billion in Medicare reimbursement by...National News
Forty-five states, including Arizona, and the Department of Justice claim that generic drug prices are fixed, and the alleged collusion may have cost U.S. business and consumers more than $1 billion.
In their filing, prosecutors say that when pharmacies asked drug makers for their lowest price, the manufacturers would rig the bidding...National News
Hundreds of lawsuits have been filed by local jurisdictions against manufacturers and distributors of powerful opioid painkillers that are fueling the nation's drug abuse crisis.
The move is part of a broader effort to more aggressively target prescription drugmakers for their role in the epidemic, Attorney General Jeff Sessions said....National News
The lawsuit claims the insurance provider submitted invalid data concerning the health status of patients enrolled in Medicare Advantage plans to the tune of more than $1 billion.
Medicare helps about 56 million people of which approximately 19 million have chosen to enroll in Medicare Advantage plans as an alternative to a standard...National News
Arrested include 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings.
CMS official Jonathan Morse said that the “largest contributors” to billing mistakes in standard Medicare were claims from home health...