Elevance Health Must Face $100 Million Medicare Advantage Fraud Case
Judge Andrew Carter ruled Elevance, formerly Anthem, must face a Department of Justice lawsuit alleging the insurer submitted fraudulent patient information. In other news, a Bay Area hospital is sued over a $6,000 urine test, and John Muir Health is sued for allegedly overcharging patients.
Modern Healthcare:
Elevance Health To Face DOJ Medicare Advantage Fraud Case
Anthem must face a Department of Justice lawsuit alleging the Medicare Advantage insurer intentionally submitted inaccurate patient information to the federal government that allowed it to fraudulently collect more than $100 million in overpayments. (Tepper, 10/4)
In other news about health care costs —
Bay Area News Group:
A $6,000 Urine Test? Bay Area Hospital Firm Sued Over 'Unconscionable' Fee
Savannah Thompson walked into the emergency department at John Muir Medical Center in Walnut Creek just after midnight June 14, fearing she had ingested fentanyl — a synthetic opiate responsible for a North America-wide epidemic of fatal overdoses — in what she had been told was cocaine, according to a new lawsuit accusing John Muir Health of fraud. (Baron, 10/4)
Becker's Hospital Review:
John Muir Health Sued For Allegedly Overcharging Patients
The law firm Hagens Berman has filed a lawsuit against Concord, Calif.-based John Muir Health accusing the health system of "unconscionable" billing practices. The proposed class-action suit alleges the health system charged a patient more than $6,000 for a routine drug screening during an emergency department visit, according to an Oct. 4 news release from the firm. (Cass, 10/4)
The Boston Globe:
After Years Of Increases, Massachusetts Health Insurance Rates Set To Rise Another 7.6 Percent
Nearly 86,000 people who purchase largely unsubsidized health insurance on the Massachusetts Health Connector will face a 7.6 percent premium increase next year, on top of increases totaling at least 31 percent since 2015. (Bartlett, 10/4)
Oklahoman:
Oklahoma DHS Implements 25% Targeted Provider Rate Increase
As part of the Oklahoma Department of Human Services' push to eliminate its 13-year waiting list for developmental disability services, the agency has implemented a 25% rate increase for providers who work with some of the state's most vulnerable individuals. (Forman, 10/4)
KHN:
$80,000 And 5 ER Visits: An Ectopic Pregnancy Takes A Toll Despite NY’s Liberal Abortion Law
When Sara Laub’s period was late, the New York City resident shrugged it off. She’d used an intrauterine device, or IUD, for three years and knew her odds of getting pregnant were extremely slim. But after 10 days had passed, Laub, 28, took a home test in early July and got unwelcome news: She was pregnant. Laub went to a Planned Parenthood clinic because she knew someone could see her immediately there. An ultrasound found no sign of a developing embryo in her uterus. That pointed to the possibility that Laub might have an ectopic pregnancy, in which a fertilized egg implants somewhere outside the uterus, usually in a fallopian tube. (Andrews, 10/5)
