False Claims Act

US Sues Rite Aid for Ignoring Glaring ‘Red Flags’ in Opioid Prescriptions

The Department of Justice filed a lawsuit against Rite Aid, accusing the pharmacy chain of filling hundreds of thousands of opioid prescriptions that had “obvious, and often multiple, red flags.” The DOJ claimed that Rite Aid violated the Controlled Substances Act by filling unlawful prescriptions for addictive drugs, as well as the False Claims Act when the chain sought reimbursement from federal healthcare programs for these prescriptions.

By Katie Adams

Legal, Hospitals

Memphis-based hospital accused of healthcare fraud involving cancer treatment

The U.S. government brought the suit against Methodist Le Bonheur Healthcare and Methodist Healthcare Memphis Hospitals, accusing the hospital system of paying millions of dollars of kickbacks to West Clinic, P.C., a cancer center with sites across the Southeast.

By Amanda James

Consumer / Employer

Health Benefit Consultants, Share Your Expert Insights in Our Survey

By MedCity News

Health Services, Health Tech, Legal

Oak Street Health stock drops on DOJ investigation

In its earnings statement, the company disclosed that it received a civil investigative demand from the Department of Justice. Specifically, the agency was looking for information on Oak Street’s relationships with third-party marketing agents and transportation services.

By Elise Reuter

Legal, Hospitals, Payers

Sutter Health to pay $90M to resolve False Claims allegations

The California-based health system will pay a hefty price to resolve allegations that it knowingly submitted inflated diagnosis codes for certain Medicare Advantage beneficiaries to receive higher payments. Sutter Health does not admit any liability in the matter.

By Anuja Vaidya

Legal, Payers

DC Circuit: Insurers have to report Medicare Advantage overpayments to CMS

Overturning a district court's decision that had earlier vacated the Medicare Advantage Overpayment Rule, the DC Circuit opened a Pandora's Box of DOJ False Claims Act litigation last week.

By Khadijah M. Silver

Legal, Hospitals

Avoid legal pitfalls in developing innovative physician-hospital payment structures

While Covid-19 requires physicians and hospitals to be more efficient than ever, a number of legal structures must be considered before providers consolidate their resources. To optimize patient care and ensure rapid payment for services, avoid running afoul of these sometimes counterintuitive regulatory schemes.

By Khadijah M. Silver

A Deep-dive Into Specialty Pharma

A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.

By PurpleLab

Legal, Health IT

EHR vendor athenahealth to pay $18M+ to settle illegal kickback allegations

The vendor has agreed to pay nearly $18.3 million to settle allegations that it violated the False Claims Act by offering illegal kickbacks to boost EHR sales. The company denies any wrongdoing and said it agreed to settle to "put the matter behind us."

By Anuja Vaidya

Legal

Recoveries down under federal False Claims Act but likely to rise again

Covid-19 may have hampered investigations and led authorities to shift resources to more obvious frauds, attorneys said. But the pandemic also created new targets to investigate, including telemedicine and CARES Act funding.

By Joel Berg

Health IT, Legal

Konica Minolta settles lawsuit alleging flaws in EHR software for $500,000

The whistleblower case alleged that an electronic health records company acquired by Konica Minolta cheated on certification tests to hide software issues.

By Elise Reuter

Payers, Legal

Whistleblower lawsuit accuses Cigna of Medicare Advantage fraud

A recently unsealed whistleblower case filed by the Department of Justice accuses Cigna of fraudulently overbilling for its Medicare Advantage plans. Allegations claim the company submitted unsupported diagnoses that resulted in “billions” in overpayments.

By Elise Reuter

With the Rise of AI, What IP Disputes in Healthcare Are Likely to Emerge?

Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.

Payers, Pharma, Legal

DOJ sues CVS subsidiary for prescription drug fraud

The Department of Justice sued Omnicare for allegedly dispensing drugs without valid prescriptions.

By Elise Reuter

Legal, Hospitals, Health Services

UHS agrees to $127M DOJ to settle behavioral health investigation

Alongside the payment, which resolves the civil aspect of the probe from the DOJ and a number of states that UHS incorrectly billed Medicare and Medicaid programs, the government has dropped the criminal investigation against the company.

By Kevin Truong

Legal

IBM pays $14.8M to settle allegiations it violated the False Claims Act

The DOJ claims that IBM subsidiary Cúram Software misrepresented its ability to meet specified technical requirements in its contract to develop Maryland's health insurance exchange website and IT platform.

By Kevin Truong

Payers

Sutter Health settles Medicare Advantage upcoding case for $30 million

Sutter Health was allegedly involved in a practice called upcoding, which refers to the submission of incorrect or exaggerated information about the health status of a beneficiary in order to receive a higher payout from CMS.

By Kevin Truong

Litigation Finance, Policy