July 16, 2020

The Perils of Email

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Email is a wonderful thing.  As a kid, or even as an adult, I rarely wrote letters because the act of addressing an envelope was too much for me.  (Please don’t judge me too harshly!) But I whip off emails to friends all the time.  While I love email, it…
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Late last week, Integra Med Analytics, a corporate whistleblower that has filed several lawsuits alleging healthcare fraud, was dealt its latest blow when the Fifth Circuit Court of Appeals declined to revive its whistleblower lawsuit against Baylor Scott & White, a hospital chain in Texas. Integra Med Analytics filed its…
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The saga of increased scrutiny of Medicare Advantage plans continues to unfold. UnitedHealthcare’s SuspensionCMS announced a suspension of one year for the UnitedHealthcare H5322 contract for not reaching the mandatory 85percent medical loss ratio (MLR). Plans must achieve that magic medical loss ratio on an annual basis. For those unfamiliar…
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Insys founder found guilty of racketeering in connection with bribes to prescribe potent opioid spray. On past Monitor Monday programs, we have reported on John Kapoor, the former CEO of opioid giant Insys Therapeutics Inc., who has been under indictment since October 2018 for alleged violations of the Anti-Kickback Statute…
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Healthcare system drops petition to the U.S. Supreme Court to challenge the constitutionality of the whistleblower provisions of the False Claims Act Last month, several media outlets reported that Intermountain Health, a Utah-based health system that operates 22 hospitals and dozens of group clinics, urgent care facilities, a home healthcare…
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Allegations were made of kickbacks in the form of co-pay waivers. Late last month, US WorldMeds, a pharmaceutical manufacturer, agreed to pay the U.S. Department of Justice (DOJ) $17.5 million  to resolve two whistleblowers’ claims that it violated the False Claims Act (FCA) by paying kickbacks to patients and doctors…
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CHS and Medhost have categorically denied all of the allegations in the complaint. As the use of electronic health records (EHRs) has expanded at a rapid pace, so too has the fraud associated with these systems. An EHR is a digital version, or database, of a patient’s paper charts. The…
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Filing focuses on generic drug costs levied by pharmacies absorbed by the pharmacy giant. In 2013, J. Douglas Strauser, a pharmacist, filed a whistleblower lawsuit against Stephen L. LaFrance Holdings Inc. and Walgreens, alleging that they overcharged Medicaid for generic drugs by not giving the government the best price. Stephen…
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Decision expected soon in the Providence lawsuit. As regular Monitor Monday listeners know, we have been closely tracking the progress of data analysis firm Integra Med Analytics’ whistleblower lawsuit against Providence Health and its consultant J.A. Thomas and Associates, Inc. (JATA), alleging a conspiracy between Providence and JATA to upcode…
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Individual policyholders in Georgia launch a class-action lawsuit against Anthem for deceptive sales. Early last week, Frances Kirby and John David Marks, two individual policyholders from Cook County, Georgia, filed a class-action lawsuit in federal court in Atlanta against Anthem and Blue Cross Blue Shield of Georgia for allegedly misleading…