From a Pennsylvania health system arguing it can’t be sued for fraud over broad statements made in advertisements to a court ruling that Anthem must pay for emergency room visits when patients assign their benefits to a third party, here are the latest healthcare industry lawsuits and settlements making headlines.
1.UPMC says it can’t be sued for fraud over ads
A former patient is suing UPMC Susquehanna for fraud, alleging the health system deliberately made false representations to the public by using phrases such as “life-changing medicine” in advertisements. The Pittsburgh-based health system says it can’t be sued for fraud over “puffery” phrases in ads.
2. 4 South Carolina physicians charged in $100M billing fraud case
Four physicians and a nurse in South Carolina were charged in a healthcare fraud and kickback conspiracy involving more than $100 million in fraudulent billings.
3. South Carolina hospital fires back at physicians claiming ‘abysmal’ care
Columbia, S.C.-based Prisma Health said physicians claiming patient safety issues at the system’s Baptist Hospital are motivated by money more than patient care.
4. Feds charge Baltimore lawyer with $25M hospital extortion plan
Federal prosecutors in Baltimore indicted a medical malpractice lawyer on attempted extortion charges, claiming he threatened bad publicity about organ transplants at University of Maryland Medical System unless UMMS paid him $25 million.
5. Mississippi pharmacy owners charged in $18M healthcare fraud scheme
Two Mississippi pharmacy owners are accused of paying and receiving kickbacks and other bribes in exchange for promoting expensive compounded drugs and dispensing them to people who didn’t need them in an $18 million healthcare fraud scheme.
6. Los Angeles hospital can force Anthem to cover ER visits, court rules
A federal appellate court ruled that Anthem is required to pay Martin Luther King Jr. Community Hospital in Los Angeles for about 75 emergency room visits from covered patients.
7. Class settlement in Mayo Clinic balance billing suit gets preliminary approval
A class-action settlement involving claims that Mayo Clinic Jacksonville (Fla.) overcharged patients treated for motor vehicle-related injuries was granted preliminary approval by a federal court Oct. 6.
8. Family sues Texas Children’s Hospital to keep son on life support
The family of a 10-month-old boy sued Houston-based Texas Children’s Hospital to prevent clinicians from taking him off life support.
More articles on legal and regulatory issues:
OSF HealthCare agrees to pay $25M to settle ‘church plan’ suit
Pennsylvania physician pays $1.2M to settle billing fraud allegations
UnitedHealth accused of illegally deflating reimbursements
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