Compliance & Legal
Deficiencies found in an audit of Cigna-HealthSpring operations has prompted the Centers for Medicare and Medicaid Services to temporarily bar Cigna from enrolling new customers to its Medicare Advantage and stand-alone prescription drug plans, and from marketing efforts, according to CMS.
Sentencing continues for family members involved in a Medicare Part D fraud scheme that bilked the system for more than $20 million and saw its perpetrators using the funds to buy luxury cars and fund other businesses, said the FBI and the U.S. Attorney's Office, Southern District of Florida.
Aria Health Systems, a major healthcare provider in Northeast Philadelphia and lower Bucks County, has settled two False Claims Act matters stemming from allegations that a cardiologist in their system performed unnecessary invasive procedures on patients and outpatients at its Torresdale facility. The second matter involves alleged violations of the False Claims Act related to overcompensation of physicians and overpayment for a trademark name while the provider was in the process of acquiring an orthopedic group in December 2012, the U.S. Attorney's Office announced in a December 23 statement.
The clinical director of a Massachusetts home nursing agency, along with the agency's co-conspiring owner and doctor who served as the agency's medical director, have been sentenced in U.S. District Court in Boston for healthcare fraud and other charges in a multi-million dollar Medicare fraud scheme, the FBI and U.S. Attorney's office announced in a Dec. 22 statement.
Coloplast Corp, an ostomy and continence care product manufacturer, has agreed to pay $3,160,000 to settle allegations it paid illegal kickbacks to a number of medical suppliers. Liberator Medical Supply Inc., one of five companies named in the kickback scheme, has agreed to pay $500,000 for their part, the U.S. Attorney's Office announced through a statement released Dec. 22 by the Boston Division of the FBI.
WellCare, a publicly traded insurer based in Florida, has filed a lawsuit against the Department of Human Services in Iowa, contesting its nixed contract to help oversee the state's Medicaid program.
Saint Peter's sued Horizon over what it said was its wrongful exclusion.
Hospital giant HCA will pay $2 million to settle a whistleblower lawsuit alleging that medically unnecessary and substandard heart surgeries were being performed at Fairview Park Hospital in Dublin, Georgia, the U.S Department of Justice said Tuesday.
The Federal Trade Commission has moved to block a proposed merger of Advocate Health Care Network and NorthShore University HealthSystem, a decision the Chicago providers said they would fight.
Former Turing Pharmaceutical CEO Martin Shkreli, who was arrested last week on charges of securities fraud and who has been reviled for hiking the price of a life-saving drug by 5,000 percent, has been terminated as CEO of KaloBios, the company announced Monday.