HSAPAY ’s Post

Providers contracted with BCBS (2008) should evaluate the potential impact of a historic $2.8 billion settlement—the largest antitrust agreement in U.S. healthcare. Transparency, claims management, and out-of-network contracting improvements are on the horizon(?), but providers must decide whether to participate or pursue individual claims for triple damages. Claw back some lost revenue!

This ruling will shake things up! Supreme Court Strikes Down 50-State Bankruptcy Deal Granting Pharma Execs Immunity from Fraud & Willful Injury "The Sacklers sought an injunction “forever staying, restraining, and enjoining” claims against them. It sought to extinguish claims for negligence, fraud and willful misconduct." - Justice Gorsuch June 30, 2024: This past week, the Supreme Court overruled the Second Circuit (and decades of bankruptcy court precedent) in Harrington vs. Purdue, a mass-torte, 50-state, 100,000 victim lawsuit. With a 5-3 majority, the Supreme Court ruled that bankruptcy law does not grant the courts the authority to issue an injunction to stop future litigation from being brought against pharma companies, pharma execs, their families, or their affiliated companies for; fraud, willful injury, negligence, and/or other claims; in exchange for paying billions of dollars for class-action settlements. ... (Info from From Karen Kingston's post) #healthcare #Adverseevents #productliability #medicalnegligence

Purdue pharma a major contributor to the opioid epidemic and the source of thousands of articles and several documentaries attempted to use bankruptcy court to limit exposure from future litigation. Not only wasn't this a legal thing bankruptcy courts could do, but to protect rich people who are still rich, via bankruptcy, from futures lawsuits from people who aren't agreeing is especially egregious ... - 500,000 dead and counting - prior to filing bankruptcy, the company distributed over $11 billion to members of the owner's family - pending claims is in excess of $40 Trillion in damages - a small group agreed to settle for $10 billion in damages (but not nearly ALL victims) but we shouldn't forget it wasn't just Purdue pharma ... distributors of the meds also settled, although they denied any wrongdoing ... AmerisourceBergen: $6.1 billion Cardinal Health: $6.0 billion McKesson: $7.4 billion And let's not forget the all-powerful consulting group that taught Purdue pharma how to increase sales with messaging and targeting physicians, McKinsey ... a merger $78 million fine for them??? - all pain should be treated - pain is the 5th vital sign (chart on EVERY patient, even a cold or rash, etc.) - the only acceptable pain level is Zero pain these were some of the phrases that became all too popular in those early days #bigpharma

Nice 2023 summary by McDermott Will & Emery. Notable trends and topics include: -Anti-Kickback Statute (AKS) Allegations Are Frequent and Far Reaching -The Return of the Stark Law -Lab Testing, Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) and Telemedicine Are Under the Government’s Microscope -Medical Necessity and Medicare Billing Rules Also Can Create False Claims -COVID-19-Related FCA Enforcement Is on the Rise -DOJ’s 2024 Priorities -Key Takeaways

Johnson & Johnson on Wednesday said it plans to pay $6.5 billion over 25 years to settle nearly all of the thousands of lawsuits in the U.S. claiming its talc-based products caused ovarian cancer, pending approval of the claimants. Those cases have for decades caused financial and public relations trouble for J&J, which contends that its now-discontinued talc baby powder and other talc products are safe for consumers. About 99% of the talc-related lawsuits filed against J&J and its subsidiaries stem from ovarian cancer. The company recorded a charge of about $2.7 billion in the first quarter to raise its reserve for talc claims to about $11 billion. The deal, pending approval by claimants, would allow J&J to resolve the lawsuits through a third bankruptcy filing of a subsidiary company, LTL Management. Courts have rebuffed J&J’s two previous efforts to resolve the lawsuits through the bankruptcy of that subsidiary, which was created to absorb the company’s talc liabilities. Although there is no guarantee of a settlement or specific settlement amount in these cases, it is estimated that talcum powder lawsuits can range between $100,000 to over $1 million. This is because some of these settlements were awarded to a group of plaintiffs, meaning they'll have to divide the amount among themselves. #johnsonandjohnsonlawsuit #johnsonandjohnsonbabypowder

These keep coming and will likely dramatically increase come January. Y'all need to go get compliant, fast! Many multi-location brands and franchise systems are implementing or considering implementing a centralized system for marketing to give to their agents/locations to use, that's locked down and compliant for lead-generation. And, they're considering mandating its use and prohibiting any other lead gen marketing or purchasing. I don't know how else you comply. Dustin Owen, CMB®, AMP and I just talked about this #tcpa impact on a webinar! If you need it, Evocalize can help. But regardless, follow TCPAWorld.com from Eric J. Troutman & team (Troutman Amin LLP), and please spread the word.

Blue Cross Blue Shield recently reached a $2.8 billion settlement in a landmark antitrust lawsuit with healthcare providers. This 12-year case highlighted allegations that BCBS limited competition, imposed administrative burdens, and underpaid providers for services. Providers who treated BCBS members from 2008 to 2024 can file claims for their share. Operational reforms, such as faster claim payments and more transparent benefit processes, will be implemented. Providers must decide whether to join the settlement or opt out to pursue their own claims. This settlement not only compensates providers but also sets the stage for critical changes in how BCBS operates. While many see this as a victory for providers, concerns remain about fair representation for out-of-network providers. #medicalclaims #antitrust #insurnace #fiduciary #healthinsurance us-beacon.com https://lnkd.in/gxXjarZC

Indiana set the threshold very low at $10M in assets for the combined entity, which virtually ensures every healthcare transaction in the state will be subject to this review. Given the states' enormous herd mentality, this type of law may be coming to a state near you. #Hospice #Homehealth #Medspa #mergersandacquisitions

"Fiscal year 2023 saw a record number of #FCA settlements and judgments (543) and civil investigative demands (1,504), with US$2.7 billion recovered by DOJ.1 The FCA allows for #trebledamages and penalties, creating massive exposure in these cases and major payments for the government and #relators. #Healthcare has consistently represented the largest focus of enforcement under the FCA and has accounted for the highest recovery. On the heels of this record year, #DOJ announced in February that #privateequity involvement in the healthcare sector will be a priority moving forward...even if private equity firms are not themselves submitting claims to the government, their actions may still subject them to #liability under the FCA...On 11 June 2024, Massachusetts Senators Ed Markey and Elizabeth Warren introduced the #CorporateCrimesAgainstHealthCareAct, aimed specifically at private equity investors in the healthcare industry...#TevaPharmaceuticals violated the #AKS and FCA by issuing over US$350 million in payments to two charities and contracted vendors to cover #Medicare copay obligations for a particular drug. The government alleged that by subsidizing the cost of the drug, patients were incentivized to purchase the drug, resulting in higher #prices for wholesalers, and ultimately yielding greater revenue for Teva. " #UnitedStatesvTevaPharmsUSAInc https://lnkd.in/eRVixCk5