July 16, 2020
By David M. Glaser, Esq. The Perils of Email
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…
June 4, 2020
By Mary Inman, Esq. and Max Voldman, Esq. Integra Med Analytics Loses Battle to Establish New Breed of Corporate Whistleblower Outsiders
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…
December 5, 2019
By Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP Medicare Advantage and the Saga of Scrutiny
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…
June 20, 2019
By Mary Inman, Esq. and Max Voldman, Esq. First major pharmaceutical executive convicted on criminal charges related to opioid crises
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…
June 6, 2019
By Mary Inman, Esq. and Max Voldman, Esq. Intermountain Drops Supreme Court Challenges to False Claims Act with Settlement of Whistleblower Suit
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…
By Mary Inman, Esq. and Max Voldman, Esq.
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…
By Mary Inman, Esq. and Max Voldman, Esq.
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…
By Mary Inman, Esq. and Max Voldman, Esq.
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…
February 21, 2019
By Mary Inman, Esq. Court Poised to Rule on Motions to Dismiss Key Whistleblower Case
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…
February 13, 2019
By Mary Inman, Esq. Lawsuit by Policyholders Targets Anthem
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…
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