Health insurer guarantees trial against healthcare provider for alleged false claims – food, medicine, health care, life sciences

Health insurer guarantees trial against healthcare provider for alleged false claims – food, medicine, health care, life sciences

Originally published January 2021 Particularly given the need to maintain ongoing working
relationships with payors who process health care providers’
claims, providers who believe that they are under investigation or
have active disputes with commercial insurers should immediately
contact counsel experienced with such disputes. The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.

According to Cigna, the defendants’ waiver of patient
copayments, deductibles, and coinsurance obligations was a
subterfuge designed to avoid Cigna’s detection of the false
claims. Cigna alleged the claims were also false because, among
other things: (i) they contained altered medical diagnosis codes so
that claims would be reimbursed at higher rates; (ii) certain
medical records were inaccurate; or (iii) they were for services
that were never rendered. When defendants failed to adequately
respond to the complaint, the federal court entered its
judgment. On January 13, 2021, a federal district court in Dallas, Texas,
entered judgment against two health care providers and their
managers, awarding $5.8 million to Cigna Health and Life Insurance
Company and its affiliates. According to Cigna’s complaint, the
company’s special investigation unit had investigated the
defendants for years, including unannounced onsite visits. Cigna
then allegedly discovered that the defendants had submitted
fraudulent claims to Cigna.

The Cigna case is only the most recent in a line of
cases brought by aggressive commercial insurers asserting
allegations that health care providers have submitted false or
fraudulent claims for payment. Such cases frequently have included
legal theories very similar to those asserted by the government in
cases brought under the federal False Claims Act (31 U.S.C. 3729,
et seq.) and its state analogues. For example, Aetna,
UnitedHealthcare, and Blue Cross & Blue Shield of Mississippi
have all recently sued several health care providers alleging the
submission of false claims for laboratory services. Complaints have
asserted causes of action under civil RICO and common law fraud,
among others, and sought millions of dollars in treble damages and
attorneys’ fees. Health care providers have seen an increase in litigation and
disputes with commercial payors.

The Biden Administration is expected to devote significant resources to investigating fraud and abuse in the health care industry. Not only will the Biden Administration likely continue… Source WilmerHale

Biden Health Care Enforcement Priorities POPULAR ARTICLES ON: Food, Drugs, Healthcare, Life Sciences from United States

The News Highlights

  • Health insurer guarantees trial against healthcare provider for alleged false claims – food, medicine, health care, life sciences
  • Check the latest Health news updates and information about health.
Disclaimer: If you need to edit or update this news from compsmag then kindly contact us Learn more

For Latest News Follow us on Google News


Latest Headlines
  • Show all
  • Trending News
  • Popular By week
Health calendar – April 20 |  Health

Health calendar – April 20 | Health

— 5 to 7 p.m. April 22, Railroad Square, Brunswick — 5 to 7 p.m., April 30, Municipal Building parking lot, 615 E. Main St., Thurmont — 1 to 3 p.m. April 24, ...
The flow of money from the state to the county is improving

The flow of money from the state to the county is improving

Commonly the townships pay the highway department to do some maintenance and construction work. Lawson said for the highway department to do more than just ...
Days gone by won the short stick

Days gone by won the short stick

This is by no means a bad thing, but by the time Days Gone was released in early 2019, this formula was anything but original and could even be seen as tired ...
Shaw assists in planting 1 billion trees and other business news

Shaw assists in planting 1 billion trees and other business news

Memphis Contract Packaging announced Monday it will invest $48 million to add a new product line and create 261 jobs at its facility in Somerville. Beauty ...
Assembly approves bill to create new health standards in work environments

Assembly approves bill to create new health standards in work environments

Source According to Assembly Speaker Carl Heastie, there are currently no specific state or federal laws protecting workers from airborne diseases. He says ...
Public health warns Mayor of Cerritos Solanki and Barrows for not wearing masks – News from the Cerritos community

Public health warns Mayor of Cerritos Solanki and Barrows for not wearing masks – News from the Cerritos community

As you know, this is a critical period in which some restrictions are being lifted in Los Angeles County as we progressed into the Red Tier under the State’s ...
Mr. Roy Andrade CTO of Cyber ​​Boy Corp.  produced a new 3D chess game

Mr. Roy Andrade CTO of Cyber ​​Boy Corp. produced a new 3D chess game

Source Sr. Roy Andrade’s mission is to produce a perfect game either in terms of graphics or animation and sound. Because he believes that the current ...
Cisco tool can help open telemetry for advanced network, security analytics

Cisco tool can help open telemetry for advanced network, security analytics

Telemetry metrics are generated from enterprise resources, such as switches, routers, wireless infrastructure and Internet of Things (IoT) systems, and used ...
'It will be safe and secure for our members here';  The Pantheon business incubator appears to remain open 24 hours a day, 7 days a week

‘It will be safe and secure for our members here’; The Pantheon business incubator appears to remain open 24 hours a day, 7 days a week

Like says, “Any time you’re trying to rebuild an entrepreneur ecosystem in a rural community it takes a few years. We didn’t get here overnight we’re not going ...
Ring camera vs. ring doorbell

Ring camera vs. ring doorbell

The Ring camera has several different models to choose from, depending on what you want for your home security. These include the Stick Up Cam Solar HD, ...
Show next
Compsmag - Latest News from tech, business and health
Logo