- In a recent Texas appellate court decision, the Court found that the relator of an FCA suit against her former employer’s client, which resulted in the former employer losing the client, was not liable to her former employer for the fallout of the FCA suit. Specifically, the Court found that the former employer had failed to show a link between the former employee’s conduct and the loss of the contract and business. For more information on the case, see, MJS and Associates LLC v. Judy Master and Matthew Master, case number 12-15-00219-cv, in the Twelfth Court of Appeals of Texas.
- UnitedHealthcare has cut certain aspects of its dialysis scheme suit in a recent amended complaint, stating that it appears that only UnitedHealthcare’s Florida plan paid fraudulent claims, i.e., claims where the dialysis provider bolstered its profits by convincing their patients to switch from government-sponsored health care to commercial plans to try to collect more reimbursements. For more information on the case, see, UnitedHealthcare of Florida Inc. et al. v. American Renal Associates Holdings Inc. et al., case number 9:16-cv-81180, in the U.S. District Court for the Southern District of Florida.
- SpecialtyCare IOM Services LLC, a surgery monitoring company in Tennessee, recently won a suit for $19 million against a competitor whom they alleged illegally poached nine employees subject to restrictive covenants from a company that the surgery monitoring company had just acquired. For more information on the suit and the restrictive covenants involved, see, SpecialtyCare IOM Services LLC v. Medsurant Holdings LLC and Medsurant LLC, case number 15-695-II, in the Chancery Court of Davidson County (Tennessee).
- Mount Sinai Health System in New York City recently agreed to settle a case brought against it by paying $3 million to resolve allegations that they violated the False Claims Act by retaining Medicaid overpayments for more than 60 days after they learned of them. This is the first lawsuit and settlement regarding the Affordable Care Act provision where it was alleged that a provider identified overpayments, but did not return them within 60 days. For more information on the case, see, Kane v. Healthfirst Inc. et al. and U.S. v. Continuum Health Partners Inc. et al., case number 1:11-cv-02325, in the U.S. District Court for the Southern District of New York.
- A California judge recently ruled that a group of prominent L.A. restaurants cannot avoid an antitrust class action against them, which argues that the eateries orchestrated a price-fixing conspiracy to cover the costs of employee health care required under the Affordable Care Act by imposing a 3% surcharge across the board at all of their restaurants starting in 2014. For more information on the case, see, Margaret Imhoff v. Suzanne Goin et al., case number BC593161, in the Superior Court of California for the County of Los Angeles.
- The Eleventh Circuit recently ruled that private insurers offering Medicare Advantage plans can sue primary insurers under the Medicare Secondary Payer Act. This was a victory for Humana Medical Plan Inc. in its suit against Western Heritage Insurance Co. over who should have to cover the cost of an injury at a Florida condominium. The Medicare Secondary Payer Act provides that when more than one insurer is liable for an insurance cost, private insurers are treated as primary payors and Medicare as a secondary payor. For more information about the suit, see, Humana Medical Plan, Inc. v. Western Heritage Insurance Com, case number 15-11436, in the U.S. Court of Appeals for the Eleventh Circuit.
- The Aetna-Humana and Anthem-Cigna antitrust suits were recently separated by a Washington D.C. federal judge into two separate suits in an effort to expedite the results of the suits so that the insurers can meet their contractual deadlines to finalize the deal or pull out of the deals. The cases are U.S. et al. v. Anthem Inc. et al., case number 1:16-cv-01493, and U.S. et al. v. Aetna Inc. et al., case number 1:16-cv-01494, both in the U.S. District Court for the District of Columbia.
- Two nonprofit health insurers recently filed suit against the Obama administration in Massachusetts and New Mexico challenging how payments are calculated in the ACA’s “risk adjustment” program, which is supposed to transfer money from insurers with healthier-than-average policyholders to insurers with sicker-than-average policyholders. For more information on the cases, see, Minuteman Health Inc. v. U.S. Department of Health and Human Services et al., case number 1:16-cv-11570, in the U.S. District Court for the District of Massachusetts, and New Mexico Health Connections v. U.S. Department of Health and Human Services et al., case number 1:16-cv-00878, in the U.S. District Court for the District of New Mexico.