Racism, sexism and now fraud: Lawsuits pile up at New Jersey ‘AI’ firm

A previous investigation by MedCity News found that ElectrifAi was touting an improperly-developed algorithm during the earliest phase of the Covid-19 pandemic, with both the company and CEO defendants in an employment discrimination lawsuit. A year later, lawsuits are piling up as more former employees complain that the company and CEO lied about its AI …

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Lawsuit: Aetna fertility coverage policy “an illegal tax” on LGBTQ people

The lawsuit alleges that an Aetna policy discriminates against LGBTQ people by requiring them to pay thousands in out-of-pocket costs for fertility treatments before becoming eligible for coverage. Though Aetna has agreed to pay the costs incurred by the plaintiffs, the suit aims to strike down the policy as a whole.

Feds slap UPMC, cardiothoracic surgery chair with billing fraud suit

The lawsuit alleges that UPMC and the chair of its cardiothoracic surgery department knowing submitted false claims for concurrent surgeries that violated regulations. But, according to UPMC, there is no regulation that prohibits overlapping surgeries or billing for them.

Insurer price transparency rule faces legal challenges: 4 takeaways

Two lawsuits, filed by the U.S. Chamber of Commerce and the Pharmaceutical Care Management Association, allege that portions of the price transparency rule governing insurers are unlawful and would drive up healthcare prices, contrary to the rule’s stated aim.

UnitedHealth subsidiaries settle mental health parity allegations for $15.6M

UnitedHealthcare and United Behavioral Health agreed to the settlement to resolve allegations that they illegally denied coverage for mental health and substance use disorder treatments. The allegations are related to business practices they no longer use, parent company UnitedHealth Group said.

BCBS of Kansas City sues Covid-19 testing provider over alleged price gouging

GS Labs, a Covid-19 testing provider, has submitted over $9.2 million in claims to the insurer as a result of its grossly inflated prices, the lawsuit states. The testing company rejected the claims, saying its “prices accurately reflect the level of service” it provides.

Supreme Court upholds ACA, dismissing constitutional challenge

The Supreme Court upheld the Affordable Care Act, dismissing the lawsuit brought by Texas, 17 other states and two individuals on the grounds that they were not able to prove they were harmed by the law. Industry stakeholders celebrated the court’s long-awaited decision.

100+ workers sue Houston Methodist over mandatory Covid-19 vaccination policy

The lawsuit alleges that the policy is akin to forcing employees to participate in a medical experiment as none of the vaccines available have received full FDA approval. But Houston Methodist rebutted these claims saying the vaccines are safe and effective, and requiring employees to get vaccinated is in the best interest of the patient.

Texas lawsuit: Biden administration threatening funding to force Medicaid expansion

Filed by the Texas attorney general, a new lawsuit seeks to prevent the Biden administration from revoking the Trump-era approval of a Medicaid waiver extension that could cost the state billions in funds. The revocation was a political move intended to force the state to expand Medicaid under the ACA, the lawsuit claims.

32 hospitals in non-Medicaid expansion states sue HHS over payments for low-income patients

The hospitals are pushing HHS to recognize patients eligible for Medicaid under the ACA as “low-income” when calculating Medicare disproportionate share hospital payments in states that did not expand Medicaid. The agency’s refusal to do so resulted in the hospitals receiving lower reimbursements for three years, the lawsuit claims.

Kaiser Permanente to shell out nearly $19M to settle discrimination lawsuits 

The California-based health system agreed to settle two lawsuits alleging unfair practices that resulted in Black and Hispanic workers being paid less and receiving fewer promotions than their white counterparts. In total, Kaiser Permanente agreed to pay $18.9 million as part of the settlements.

Stanford Health Care seeks up to $1.9M from Anthem in new suit

The California-based provider has filed a lawsuit against the payer, claiming Anthem has yet to pay for the care it provided to patients covered by its affiliate. Stanford and Anthem had an implied contract, and if it is not upheld by the court, the provider is seeking $1.9 million in reimbursement.

Centene refutes Ohio AG’s lawsuit, says it reflects misunderstanding of Medicaid billing

Centene has rebutted the accusations made in a sealed lawsuit filed by the Ohio attorney general that accused the insurer of over-billing the state’s Medicaid department. The lawsuit is based on a misunderstanding of how Medicaid billing operates and should be unsealed, Centene said.

Centene’s “corporate greed” led it to allegedly overcharge Ohio’s Medicaid department

The Ohio attorney general has filed a lawsuit alleging that a Centene subsidiary, which provides Medicaid services in the state, hired multiple companies to administer pharmacy benefits in order to inflate costs. As a result, the state’s Medicaid department paid millions in overcharges.

Insurers sue ‘pharma bro’ Martin Shkreli, company for alleged price gouging

Blue Cross and Blue Shield of Minnesota has filed a class-action lawsuit — on behalf of itself and insurers from 30-plus states — against Martin Shkreli and Vyera Pharmaceuticals. The suit alleges the defendants intentionally monopolized the market for Daraprim to raise the price of the drug by more than 4,000%.

Tenet ordered to pay $10M+ to fired physicians, restore medical privileges

Two cardiologists claimed they were fired from Tenet’s Detroit Medical Center for raising concerns about patient care, though the medical center says they were let go for behaving unprofessionally. Following an arbitration process, a federal court in Michigan has ruled that Tenet must pay the physicians $10.6 million and reinstate their medical privileges.

46 hospitals file suit to reverse HHS bad debt policy

A group of hospitals have sued HHS Secretary Alex Azar, arguing he should reverse a policy that prevents hospitals from getting reimbursed for Medicare-related bad debts pending at outside collection agencies. The policy has raised hospital debt payments by about $1.35 million, the lawsuit claims.

Lawsuit accuses HCA of failing to protect healthcare workers during pandemic

After four Riverside Community Hospital employees contracted Covid-19, they and their families sued HCA for failing to provide adequate protections. The plaintiffs said they were not given adequate access to PPE, not warned when they might have been exposed to Covid-19, and were encouraged to come back to work, even when they still had Covid-19 …

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District judge blocks HHS rule that would end transgender health protections

A U.S. district judge blocked a rule by the Department of Health and Human Services that would end anti-discrimination provisions protecting transgender patients. In his decision, U.S. District Judge Frederic Block said that the rule violated a recent Supreme Court decision protecting LGBTQ workers’ rights.