How the DOJ Is Tackling Fraud in the ACA Marketplace
At the Medicarians Conference, Ricardo Carcas, assistant special agent in charge of the Office of Investigations, discussed cases of fraud in the ACA and how the DOJ is combatting it.
DOJ Cracks Down on Unfair Contracts with New Lawsuit Against NewYork-Presbyterian
The Department of Justice filed an antitrust lawsuit against NewYork-Presbyterian, alleging the hospital used “all-or-nothing” contracts that blocked lower-cost plans and limited competition. The case comes just five weeks after the Justice Department filed a similar lawsuit against OhioHealth.
The Hidden Administrative Tasks Draining Small Practices
Small practices play a critical role in healthcare delivery, but they cannot continue to absorb ever-increasing administrative demands without consequences.
DOJ: UHG, Amedisys Must Divest 164 Locations for Acquisition to Proceed
The Department of Justice has reached a proposed settlement with UnitedHealth Group and Amedisys regarding UnitedHealth’s acquisition of the home health provider, which includes the divestiture of 164 home health and hospice locations.
DOJ Sues MA Insurers, Brokers Over Alleged Kickbacks
The Department of Justice has filed a complaint against Aetna, Elevance Health, Humana, eHealth, GoHealth, and SelectQuote, alleging that the insurers paid illegal kickbacks to brokers to boost enrollment in their Medicare Advantage plans.
Why the DOJ’s Lawsuit Against the UGH-Amedisys Merger May Not Go Anywhere
Experts aren’t sure what the outcome of the DOJ’s recent lawsuit against the proposed UnitedHealth Group/Amedisys merger will be under the incoming Trump administration. The Biden administration has focused more on supporting clinicians, while the previous Trump administration favored corporations. Additionally, one expert noted that this case differs from other antitrust lawsuits because it does not seem to focus on a potential price increase.
DOJ Launches Task Force on Healthcare Monopolies: Will It Make A Difference?
The U.S. Department of Justice recently launched a task force on healthcare monopolies. Experts have varying opinions on how it will impact the healthcare industry.
The Power Behind Enterprise EHR Software for Large Healthcare Systems
Enterprise EHR boosts scalability, interoperability, and governance for large healthcare systems.
Teva, Glenmark To Pay $255M, Divest Cholesterol Drug to Settle DOJ Price Fixing Charges
Generic drugmakers Teva and Glenmark recently became the sixth and seventh drugmakers to resolve criminal charges as a result of the DOJ’s yearslong investigation into generic drug price fixing. The settlement agreement requires both companies to pay hefty fines as well as divest their drug lines for pravastatin, a widely used statin that lowers cholesterol.
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.
Purdue to plead guilty, pay $8.3B deal to resolve opioid charges
In addition to monetary damages and the guilty pleas, the government is seeking to transform the maker of OxyContin into a public benefit company that would fund efforts to curb opioid abuse and give away drugs to prevent overdose deaths.
Florida man convicted in $1.3B Medicare and Medicaid fraud scheme
After an eight-week trial, Philip Esformes was found guilty for his role in a fraud scheme that involved more than $1.3 billion in fraudulent claims to Medicare and Medicaid for services that weren't provided, weren't medically necessary or were procured through the payment of kickbacks.
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Survey on the Healthcare Financial Landscape Offers a Roadmap for Stakeholders
Zelis highlights how employers, payers, and consumers are integrating digital tools to manage healthcare costs.
Four men, seven companies indicted for $1B telemedicine fraud scheme
The indictment alleges that as part of the scheme, which ran from June 2015 to April 2018, the defendants submitted no less than $931 million in fraudulent claims for payment.
eClinicalWorks to pay $155 million to settle false claims suit
eClinicalWorks and some of its employees will pay $155 million to settle claims that the EHR vendor misrepresented the capabilities of its software and paid kickbacks to certain customers in exchange for promoting its product.
Court upholds decision to block $54 billion Anthem-Cigna merger (updated)
There's been a new development in the Anthem-Cigna merger saga: On Friday, a U.S. appeals court upheld a lower court's earlier decision to block the $54 billion deal.
Mylan settles EpiPen Medicaid rebate case for $465M, stock jumps
Mylan settled with the U.S. Department of Justice to head off potential Medicaid liability claims by federal and state governments.
DOJ questions McKesson-Change Healthcare venture (Updated)
The U.S. Deparment of Justice is requesting more information from McKesson and Change Healthcare before signing off on the two companies' plans to combine health IT operations into a new, $3.4 billion business.