From an insurer accused of systematically denying coverage for cancer treatment to a Texas heart hospital agreeing to pay $48 million to settle false claims allegations, here are the latest healthcare industry lawsuits and settlements making headlines.
1. Duke Health, Geisinger sue HHS over Medicare payments
Five hospitals sued HHS Dec. 21 over its calculation of Medicare Part A disproportionate share hospital payments for patients who were enrolled in Medicare Advantage plans under Part C of the Medicare Act.
2. Massachusetts home health agency to pay $10M to settle false claims charges
A Massachusetts home health company and its CEO will pay $10 million to settle charges of falsely billing the state's Medicaid program.
3. New York pharmacy owners charged in $30M COVID-19 scam
The owners of more than a dozen pharmacies in New York City and Long Island were arrested and charged for their roles in an alleged $30 million healthcare fraud and money laundering scheme.
4. Lawsuit accuses Aetna of systematically denying coverage for cancer treatment
A Florida man filed a class-action lawsuit against Aetna Life Insurance Co., claiming it systematically denied coverage for a cancer treatment called proton beam radiation therapy.
5. Florida physician pleads guilty to $29M fraud
Moses D. deGraft-Johnson, MD, pleaded guilty Dec. 18 to 56 counts of healthcare fraud, conspiracy to commit healthcare fraud and aggravated identity theft.
6. US sues Walmart, says its pharmacies fueled opioid crisis
The U.S. Justice Department filed a lawsuit against Walmart Dec. 22 alleging the supermarket giant contributed to the opioid crisis by failing to properly screen its pharmacies for abusive prescribing practices.
7. Texas hospital pays $48M to settle false claims allegations
Texas Heart Hospital of the Southwest in Plano agreed to pay $48 million to resolve allegations that it knowingly submitted false claims to Medicare.
8. Cardiologist claims Colorado system fired her 1 day after she told CEO concerns of understaffing
A cardiologist claims that Broomfield, Colo.-based SCL Health fired her out of retaliation one day after she emailed the system CEO with concerns about specialist understaffing.