The Villages (Fla.) Health, a primary and specialty care provider group, has agreed to pay $541.5 million to resolve allegations that it violated the False Claims Act by submitting improper Medicare Advantage diagnosis codes, according to an Aug. 26 news…
Legal & Regulatory Issues
A Portland, Ore., man is suing Oakland, Calif.-based Kaiser Permanente for nearly $534 million, alleging the health system and several physicians failed to properly diagnose and treat a heart condition that led to cardiac arrest and the amputation of both…
A former senior director of data analytics at Optum has been sentenced to three years in federal prison for creating a no-show job for a friend and pocketing kickbacks from their salary. Karan Gupta, 48, of Walnut Creek, Calif., was…
Canada’s Department of Finance said that it will impose counter-tariffs on U.S. goods, effective Sept. 8, in response to President Donald Trump’s 50% tariff on $27.6 billion of Canadian goods that took effect Aug. 22. Here are five things to…
The Federal Trade Commission approved a final consent order Aug. 25 that resolves antitrust concerns tied to Ascension’s $3.9 billion acquisition of ASC operator Amsurg. The FTC voted 2-0 to approve the final order after a public comment period, according…
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The Department of Homeland Security is proposing a new $103,265 fee for H-1B petitions, just months after a federal judge struck down the Trump administration’s earlier attempt to impose a similar charge. The rule, published Aug. 25 in the Federal…
Tennessee-based in-home care provider Monogram Health has agreed to pay $2.4 million to settle allegations that it caused the submission of false diagnosis codes to boost Medicare Advantage payments. From Jan. 1, 2021, through Dec. 31, 2023, Monogram allegedly knowingly…
A union health and welfare benefit fund filed a class action antitrust lawsuit Aug. 19 against Columbus-based OhioHealth, alleging the system’s contracts with insurers blocked lower-cost plan designs and inflated what payers paid for care, according to court documents accessed…
More than 200 healthcare organizations urged CMS not to finalize proposed limits on remote monitoring, warning the changes would disrupt care for about 1 million Medicare beneficiaries who manage chronic conditions from home. In a sign-on letter to CMS Administrator…
EmblemHealth issued New York City-based Mount Sinai Health System’s independent practice association a cease-and-desist letter regarding its decision to stop accepting new patients from some of the insurer’s government-backed plans. The insurer sent Vincent Tammaro, Mount Sinai’s executive vice president…