Between Theranos, Anthem and Cigna and an onslaught of big-dollar settlements, 2016 was a busy year when it came to healthcare-related legal wranglings. As always, Healthcare Finance News was there. Here are the top 14 compliance and legal stories of the past year.
21st Century Oncology probes massive data breach as it settles fraud case for $34.7 million
"Fort Myers, Florida.-based 21st Century Oncology, which operates 145 centers across the United States and 36 in Latin America, said it is investigating a breach of its computer network that could affect 2.2 million of its former and current patients. The news comes as the provider on Thursday also agreed to settle a billing fraud case for $34.7 million."
To read more: http://www.healthcarefinancenews.com/news/21st-century-oncology-probes-m...
Dallas doctor convicted in landmark $375 million fraud case, largest ever in home health
"Dallas physician Jacques Roy faces decades behind bars and millions in fines after a federal jury convicted him of multiple counts of healthcare fraud, conspiracy, making false statements and obstruction of justice on Wednesday, the Department of Justice announced.
Roy's conviction, along with three home health agency owners, is the culmination of a six-week trial in which the jury deliberated for less than two days before delivering their verdict on the landmark $375 million scheme. The DOJ confirmed this is the biggest home health fraud ever for Medicare and Medicaid."
To read more: http://www.healthcarefinancenews.com/news/dallas-doctor-convicted-l-375-...
Pfizer, Wyeth will pay $784.6 million to settle allegations they underpaid drug rebates to Medicaid
"Drug companies Wyeth and Pfizer have agreed to pay $784.6 million to settle allegations that Wyeth did not provide the same drug discounts to Medicaid that it gave to private buyers, the U.S. Attorney's office announced Wednesday."
To read more: http://www.healthcarefinancenews.com/news/pfizer-wyeth-will-pay-7846-mil...
Judge says federal government illegally spent billions, in decision that could gut insurers participation in ACA
"A federal judge has ruled that part of the Affordable Care Act is unconstitutional because it appropriates funds not approved by Congress.
The politically-divided case is expected to be appealed and a final decision may be handed down after the election of the next president."
To read more: http://www.healthcarefinancenews.com/news/judge-says-federal-government-...
Highmark sues federal government to recover $223 million it claims it is owed in ACA payments for 2014
"Highmark is suing the federal government to recover $223 million it claims it is owed under the Affordable Care Act.
The Centers for Medicare and Medicaid Services has paid $27.3 million out of the $223 million Highmark is owed for 2014 under the ACA's risk corridor program, the company said."
To read more: http://www.healthcarefinancenews.com/news/highmark-sues-federal-governme...
More defendants plead guilty in $600 million 'Operation Spinal Cap' fraud
"Three additional defendants, including the son of a southern California hospital owner, have pleaded guilty in an elaborate healthcare fraud scheme that authorities say spawned tens of millions of dollars in illegal kickbacks for patient referrals, and nearly $600 million in fraudulent bills for spinal surgeries performed at Pacific Hospital in Long Beach, the Justice Department announced."
To read more: http://www.healthcarefinancenews.com/news/more-defendants-plead-guilty-6...
301 people charged in massive $900 million false billings Medicare fraud
"A nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts resulted in criminal and civil charges Wednesday against 301 individuals -- including 61 doctors, nurses and other licensed medical professionals -- for their alleged participation in healthcare fraud schemes involving about $900 million in false billings. Twenty-three state Medicaid Fraud Control Units also participated in the arrests."
To read more: http://www.healthcarefinancenews.com/news/301-people-charged-massive-900...
Embattled Theranos founder Elizabeth Holmes banned from blood-testing business for two years
"The Centers for Medicare and Medicaid Services announced Thursday that it has barred Theranos founder and CEO Elizabeth Holmes from the blood-testing business for two years, according to a statement on the company's website."
To read more: http://www.healthcarefinancenews.com/news/embattled-theranos-founder-eli...
North Carolina hits Blue Cross Blue Shield with record $3.6 million fine
"The North Carolina Department of Insurance has slapped the state's Blue Cross Blue Shield with a $3.6 million penalty for IT problems that allegedly resulted in poor customer service for both its members and providers, according to the insurance commissioner."
To read more: http://www.healthcarefinancenews.com/news/north-carolina-hits-blue-cross...
Tenet Healthcare to pay $513 million over referral, kickback scheme, DOJ says
"Tenet Healthcare Corp. and two of its Atlanta-area subsidiaries have agreed to pay a total of $513 million to settle allegations of a scheme in which its hospitals paid bribes and kickbacks to prenatal clinic owners in exchange for referral of patients for labor and delivery services to Tenet facilities, the Department of Justice and multiple other agencies jointly announced Monday."
To read more: http://www.healthcarefinancenews.com/news/tenet-healthcare-pay-513-milli...
Mylan will pay $465 million settlement over CMS classification of epipen for Medicaid Drug Rebate Program
"Mylan, the pharmaceutical company that has come under fire in recent weeks for hiking the price of its emergency allergy medication injector EpiPen, has agreed to a $465 million settlement with the U.S. Department of Justice. The settlement, according to Mylan, is to "resolve questions" that have been raised about the EpiPen's classification for purposes of the Medicaid Drug Rebate Program."
To read more: http://www.healthcarefinancenews.com/news/mylan-will-pay-465-million-set...
Ten more defendants charged in $100 million Tricare fraud operation
Texas doctors, pharmacy owners, and marketers were among 10 people arrested Friday, the latest to be charged in a $100 million healthcare fraud scheme against Tricare, the health insurance program for members of the military and their families."
To read more: http://www.healthcarefinancenews.com/news/ten-more-defendants-charged-10...
Anthem, Cigna trial starts as AMA comes out against the mega-merger
"As Anthem, Cigna and the Department of Justice begin their court battle Monday, the American Medical Association has weighed in on the proposed merger saying that consolidation would result in higher premiums, not the promised efficiencies and lower costs."
To read more: http://www.healthcarefinancenews.com/news/anthem-cigna-trial-starts-ama-...
Illinois Medicaid backlog spawns multiple lawsuits on behalf of providers, beneficiaries
"A massive backlog in Medicare and Medicaid applications and payments has spawned at least seven lawsuits that have been filed against the Illinois Department of Healthcare and Family Services, said attorney Chad Bogar, Managing Partner and CEO with sb2 Inc., a law firm specializing in Medicare/Medicaid Eligibility and Reimbursement cases."
To read more: http://www.healthcarefinancenews.com/news/illinois-medicaid-backlog-spaw...
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