lawsuit
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Bon Secours Mercy Health Sues Anthem Health Plans of Virginia for Unpaid Claims
In a new lawsuit, Bon Secours Mercy Health Virginia alleges that Anthem Health Plans of Virginia owes the health system more than $93 million in outstanding unpaid and underpaid claims.
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Payer’s Place: Dr. Anil Singh
Dr. Anil Singh shares his insights into the strategies employed by the organization to identify the most effective digital solutions for their members.
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CMS Lowers No Surprises Act Fee After Court Nixes Price Hike
CMS recently announced that it will change the administrative fee that providers and insurers must pay when initiating a reimbursement dispute under the No Surprises Act — the agency is lowering the fee from $350 to $50. This move came a week after the Texas Medical Association won a court case challenging HHS over its 600% price hike on the fee.
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Nektar Sues Eli Lilly, Claiming the Big Pharma Breached Contract to Favor Another Drug
“Botched math” in calculating clinical data for an autoimmune disease drug is one of the allegations Nektar Therapeutics makes in a legal complaint against Eli Lilly. The biotech claims its former partner tried to disadvantage the asset in order to advance development of another drug it acquired in a billion dollar deal.
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Consumer / Employer, Legal, Payers
Labor Department Sues UnitedHealth Group Over ‘Thousands’ of Claims Denials
The Labor Department recently sued UnitedHealth Group subsidiary UMR, alleging that it wrongfully denied claims for emergency room services and urinary drug screenings since 2015. UMR did not determine the medical necessity of the claims, denying them “based solely on diagnosis codes and not applying a prudent layperson standard,” according to the complaint.
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Startup Sues Athenahealth, Alleging Trade Secret Theft & Deceptive Practices
Digital health startup Dorsata filed a lawsuit against EHR provider athenahealth and women’s health company Unified Women’s Healthcare. The startup alleged that athenahealth stole trade secrets, used deceptive business practices and breached its contract — and that Unified aided and abetted these purported practices.
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The Kraft Heinz Lawsuit Against Aetna Is the ‘Tip of the Iceberg’
Kraft Heinz recently sued Aetna, claiming that the insurer is not providing all of Kraft Heinz’s medical claims data. More lawsuits of this sort are likely to come, experts warned.
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Lawsuits Against Medicare Drug Negotiations Are Mounting, But They Probably Won’t Be Able to Stop The Plan
Lawsuits filed in opposition to the White House’s drug pricing negotiation program are beginning to mount, but legal experts agree that the plaintiffs’ arguments probably won’t hold up during a court battle. However, these lawsuits still could delay when the government’s ability to negotiate price goes into effect.
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Unions File Antitrust Complaint Against UPMC & Allege ‘Draconian’ Labor Practices
A group of labor unions have filed an antitrust complaint against UPMC. They alleged that the health system has prevented its workers from being able to advocate for themselves and their patients through “a draconian system of mobility restrictions and widespread labor law violations that lock in sub-competitive pay and working conditions.”
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Discover the Next-Gen Platform for Integrated Collaborative Care
Beyond EHRs and digital front doors, reducing the gaps in patient care journeys.
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DOJ accuses Kaiser Permanente of Medicare Advantage fraud in new complaint
The California-based health system and insurer has bilked CMS out of “hundreds of millions of dollars” by submitting claims that were altered to make patients appear sicker than they were, a new complaint filed by the DOJ alleges. Kaiser denied these allegations saying it is confident in its compliance with Medicare Advantage program requirements.
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CVS sues pharmacy benefit startup Capital Rx over ‘unenforceable’ non-compete clause
After Capital Rx’s former medical director of pharmacy services got a job offer at CVS, the PBM startup claimed he couldn’t work there because of a noncompete agreement. CVS recently sued the company, saying its non-compete clause was unenforceable.
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Racism, sexism and now fraud: Lawsuits pile up at New Jersey ‘AI’ firm
A previous investigation by MedCity News found that ElectrifAi was touting an improperly-developed algorithm during the earliest phase of the Covid-19 pandemic, with both the company and CEO defendants in an employment discrimination lawsuit. A year later, lawsuits are piling up as more former employees complain that the company and CEO lied about its AI capabilities and business.
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Lawsuit: Aetna fertility coverage policy “an illegal tax” on LGBTQ people
The lawsuit alleges that an Aetna policy discriminates against LGBTQ people by requiring them to pay thousands in out-of-pocket costs for fertility treatments before becoming eligible for coverage. Though Aetna has agreed to pay the costs incurred by the plaintiffs, the suit aims to strike down the policy as a whole.
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Justice Department sues Texas to block restrictive abortion law
The Biden administration has issued a legal challenge to invalidate the controversial Texas law that bans abortions after six weeks of pregnancy claiming that it will strip residents of their constitutional rights.
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Feds slap UPMC, cardiothoracic surgery chair with billing fraud suit
The lawsuit alleges that UPMC and the chair of its cardiothoracic surgery department knowing submitted false claims for concurrent surgeries that violated regulations. But, according to UPMC, there is no regulation that prohibits overlapping surgeries or billing for them.