CVS Unit Must Pay Nearly $290 Million in Medicare Whistleblower Lawsuit, Judge Rules
In an Aug. 19 decision, Judge Mitchell S. Goldberg of the Eastern District of Pennsylvania tripled to $285 million the original damages he ordered CVS Caremark to pay in June, citing the federal False Claims Act. He also added a $4.87 million civil fine.
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Business Wire
2 hours ago
- Business Wire
Blue Cross Blue Shield of North Dakota to Join Cambia Health Solutions as Newest Affiliated Single-State Blue Plan
PORTLAND, Ore. & FARGO, N.D.--(BUSINESS WIRE)--Cambia Health Solutions (Cambia) and Blue Cross Blue Shield of North Dakota (BCBSND) today announced a strategic affiliation to better serve members with access to care that's simpler and more affordable — and remains close to home. The affiliation will unify all operations and enable the organizations to share best practices for local plan innovation and services, deliver personalized member experiences and leverage Cambia's robust technology infrastructure. Strategic affiliation to better serve members with access to care that's simpler and more affordable — and remains close to home. Share Established in 1995 by four Blue Cross Blue Shield licensees, Cambia is a nonprofit health solutions company that provides management and shared services for local Blue plans across the Pacific Northwest and Mountain West, all connected by a common focus on delivering more for members. 'Affiliating with Cambia allows us to leap ahead in the capabilities we can bring to the North Dakotans we serve,' said Dan Conrad, president and CEO of BCBSND. 'We both have a deep commitment to a strong local presence today and into the future. Backed by Cambia's national scale and resources, we can offer members and customers more affordable plan solutions and personalized health tools, all while continuing to be supported by local employees who understand their health care needs.' Cambia and BCBSND share a legacy of practical innovation and community commitment. Cambia's mission is to transform health care to work better for real people and be economically sustainable. It is a founding partner and investor in Echo Health Ventures, which seeks to invest in and grow great health care companies. The health solutions company brings experience offering high-quality, cost-effective health care through personalized member tools that make it easier for people to navigate their care. BCBSND contributes deep expertise and market leadership in rural health, Medicare and Medicaid solutions, and provider collaboration. 'Cambia works every day to make health care easier and lives better for our members. For decades we've proven that we can do more when we have partners who share in this work,' said Jared Short, president and CEO of Cambia. 'BCBSND's culture and vision fit perfectly as we work together to innovate and transform health care for the communities we serve.' Members retain their current coverage and will continue to use their BCBSND insurance card just as they do today. BCBSND will continue to offer Medicare Advantage through NextBlue of North Dakota. BCBSND will maintain its local plan name, board of directors, and philanthropic foundation. It will also continue its mutual status, meaning it will remain governed by voting policyholders rather than investors. All BCBSND's reserve funds and foundation resources remain in North Dakota. Cambia will also maintain its foundation, and local health plans will operate in Idaho, Oregon, Utah, and Washington, as they do now. The areas of focus for the affiliation include: Improving the care experience with more personalized and connected solutions for members and providers. The affiliation enables investment in care solutions such as advanced primary care, mobile platforms for on-demand and virtual primary care, expanded tools for maternal and family health, and programs tailored to local communities. The affiliation enables investment in care solutions such as advanced primary care, mobile platforms for on-demand and virtual primary care, expanded tools for maternal and family health, and programs tailored to local communities. Expanding capabilities and tools to meet the unique local health needs of members and communities. Shared technology and data will create new opportunities for plans to collaborate with providers, employers and communities to support care that is more accessible, understandable and actionable for members and providers. Shared technology and data will create new opportunities for plans to collaborate with providers, employers and communities to support care that is more accessible, understandable and actionable for members and providers. Investing in transformative, financially sound solutions to improve members' health outcomes. Combined resources across operations and technology will increase agility, expand plan capabilities, provide cost savings, and simplify the experience for members and customers. The strategic affiliation is subject to regulatory approval in North Dakota and is expected to close in 2026. For more information, visit the fact sheet. About Blue Cross Blue Shield of North Dakota BCBSND was founded in 1940 with the mission to provide members with affordable access to health care across the state. As an independent licensee of the Blue Cross and Blue Shield Association (BCBSA), BCBSND is committed to transforming care and health across the state to improve outcomes, lower cost trends and make it easier to shop, buy and use health care coverage. Members have access to unmatched local service and to a comprehensive network of health care providers across the state, the nation and more than 190 countries. About Cambia Health Solutions Cambia Health Solutions, headquartered in Portland, Oregon, is dedicated to transforming health care. We put people at the heart of everything we do as we work to make the health care system more economically sustainable and efficient for people and their families. Our company reaches millions of Americans nationwide, including more than 3.6 million people served by our regional health plans. To learn more about us, visit
Politico
4 hours ago
- Politico
Lawmakers offload UnitedHealth stock
With help from Carmen Paun PROGRAMMING NOTE: Pulse will be on hiatus from Aug. 25 through Sept. 1. We'll be back to our normal schedule on Tuesday, Sept. 2. Driving the Day STOCK ACTIVITY — Some Washington policymakers with financial stakes in UnitedHealth Group are selling their stocks in the company as it struggles financially and the Trump administration investigates its billing practices, Kelly reports. Lawmakers of both parties have sold off UnitedHealth stock worth as much as $1.2 million, against $950,000 in purchases this year, according to a POLITICO review of stock trading. An uptick in sales in recent months comes as Congress and the Trump administration probe the health care behemoth over billing practices and how often it denies care. Why it matters: Congress members' stock sales are legal even though some of them sit on committees that oversee the insurance industry. The sales come amid an effort in Congress to ban members from trading stocks to prevent conflicts of interest — which some lawmakers have said they support and cite as justification for their decisions to sell. Dan Weiskopf, an investment portfolio manager at Tidal Financial Group who tracks congressional stock trading, said if he were an investor in the insurer, he'd 'be very concerned when I saw that the regulators, as members of Congress, are dumping the stock. That's very clearly a red flag.' Background: Bipartisan lawmakers in Congress have signaled interest in cracking down on overpayments to the privately run Medicare Advantage program, in which UnitedHealth Group has a large stake, and probing excessive care-denial claims. Additionally, the Department of Justice is investigating the company's Medicare billing practices. The Wall Street Journal first reported a civil DOJ investigation in February, and in the week following, Democratic California Reps. Ro Khanna and Gil Cisneros and Republican Indiana Rep. Jefferson Shreve collectively sold up to $150,000 in UnitedHealth Group stock. All of Khanna's UnitedHealth stock is in trusts belonging to his children and spouse. A spokesperson for Shreve said the representative has not traded personally-held stocks as a member of Congress, and that he recently directed the assets manager of his charitable trust to divest from individual stocks. Cisneros' spokesperson said his stock trades are managed by outside financial advisers. 'I don't trade any stocks and have pushed for a ban on stock trading, leading the effort to pass the TRUST in Congress Act,' said Khanna, a member of the Oversight and Accountability Committee, the House's main investigative arm, in a statement. That bill would require members of Congress to place their assets in blind trusts. Rep. David Taylor (R-Ohio) sold up to $65,000 in company shares on the same day in May that The Wall Street Journal reported the DOJ had launched a criminal probe into the company's Medicare billing practices. The next day, Rep. Jared Moskowitz (D-Fla.) sold shares worth up to $45,000 — some of it owned by his children. Rep. Robert Bresnahan (R-Pa.) sold stock worth as much as $50,000. Taylor, Moskowitz and Bresnahan did not respond to requests for comment. Even so: Some lawmakers who sold their UnitedHealth Group stocks this year said they are divesting all of their shares in support of the congressional push to remove conflicts of interest. That includes freshman Rep. Julie Johnson (D-Texas) and Rep. Greg Landsman (D-Ohio), according to their spokespeople. Johnson sold UnitedHealth stock worth up to $30,000 between April and July, and Landsman reported selling stock — owned by his spouse — worth up to $50,000 in March. WELCOME TO THURSDAY PULSE. High levels of exposure to technology can be cognitively harmful to children and teens, data has shown, but researchers are finding that the opposite is true for older adults. Send your tips, scoops and feedback to khooper@ and sgardner@ and follow along @kelhoops and @sophie_gardnerj. At the Agencies HUNDREDS OF CDC WORKERS LET GO — About 600 CDC employees are receiving permanent termination notices after a court ruling last week paved the way for the agency to move forward with some firings, according to the union representing agency workers. The cuts are across the Division of Violence Prevention, Office of Equal Employment Opportunity, the Freedom of Information Act office, the Office of Financial Resources and the offices of the chief information and chief operating officers, said a spokesperson for the American Federation of Government Employees, which represents more than 2,000 dues-paying members at the CDC. HHS referred POLITICO to a March announcement on agency restructuring. Background: A U.S. district court judge agreed last week to narrow an injunction that had been blocking the Trump administration's plan to fire hundreds of CDC employees. The injunction had initially blocked HHS from terminating any CDC employees, but the revised order blocks only six of the agency's centers from the reduction in force. The centers still blocked from terminations include the CDC's National Center for HIV, Viral Hepatitis, STD and Tuberculosis Prevention; the Division of Reproductive Health; the National Institute for Occupational Safety and Health; the Office on Smoking and Health; the National Center for Environmental Health; and the National Center on Birth Defects and Developmental Disabilities. Key context: The terminations come as CDC employees are dealing with the impact of a shooting earlier this month that targeted the agency's headquarters in Atlanta. Eye on Insurers EMPLOYERS WORRY ABOUT COSTS — Most small and mid-sized businesses offering their workers group health insurance are concerned they won't be able to afford the benefit within three years, according to a new survey from health insurance marketplace eHealth. The findings come as employer health costs are projected to jump 9 percent next year, the highest increase since at least 2017, according to a Business Group on Health survey published earlier this week. The spike comes as more Americans seek out medical care and are prescribed costly medications, like weight-loss drugs. Most Americans under 65 — more than 160 million people — are enrolled in health insurance through their employers. eHealth's findings: Nearly 90 percent of the businesses surveyed said they're concerned health benefits will be too costly to provide to employees within three years. Three-quarters of the respondents said they'd be in favor of switching to a health benefits model called an Individual Coverage Health Reimbursement Arrangement, or ICHRA, which allows employers to offer their workers a tax credit to purchase health insurance on the Affordable Care Act exchange in lieu of a group plan. But more than half of the respondents said they're unfamiliar or uneducated on the policy. Background: The arrangements — a Trump first-term policy — have gained some traction recently, as employers grapple with the high costs and administrative burden that come with offering traditional group plans. But changes to the ACA enacted in the Republicans' megabill, the expiration of enhanced federal Obamacare subsidies at year's end and a new Trump administration marketplace rule could lead to fewer young and healthy people enrolled in the ACA market and higher premiums — making offering ICHRAs less attractive for employers, policy experts recently told POLITICO. Key context: The national survey was conducted in July among 503 owners and managers of small to mid-sized businesses — those with 500 employees or fewer. Global Health NOT OUT OF THE MEASLES WOODS — The Texas measles outbreak might be over, but the U.S. measles-free status is still at risk, according to the Pan-American Health Organization, the regional arm of the World Health Organization, Carmen reports. Other states have reported cases linked to the Texas outbreak, a PAHO spokesperson said, pointing to New Mexico as an example. The Idaho health department reported a third confirmed measles case Wednesday, in an unvaccinated child. 'To maintain measles elimination status, a country must have controlled and ended all outbreaks related to the first case identified (in this case, in Texas) within twelve months,' the PAHO spokesperson said via email. Names in the News Accountable for Health, an advocacy organization committed to accelerating the adoption of effective value-based care, is adding Patrick McConnell as director of federal affairs. McConnell, an alumnus of former Rep. Max Rose (D-N.Y.), previously was director at Rational 360 and graduated from Hamilton College. WHAT WE'RE READING POLITICO's Tyler Katzenberger reports on California policy influencers supporting harsher social media laws than the state's voters. KFF Health News' Fred Clasen-Kelly and Renuka Rayasam report on the toll of the nation's gun violence epidemic.
Yahoo
4 hours ago
- Yahoo
InfoAging launches care team finder platform in Florida for senior healthcare
InfoAging, a senior-focused health directory in the US, has launched which is claimed to be Florida's first comprehensive 'care team finder' platform. The service aims to address coordination challenges in the state's fragmented senior healthcare system by enabling families to build a multidisciplinary team of specialists for ageing-related conditions. The system is said to be designed to reduce preventable hospital readmissions and ease the burden on more than 2.8 million family caregivers. Nearly one in five Medicare patients in Florida is stated to be readmitted to the hospital within 30 days of discharge. According to InfoAging, these repeated hospitalisations reflect broader weaknesses in healthcare coordination. The issue contributes to billions in costs and creates enduring pressure on family caregivers. Poor system coordination also contributes to preventable medical errors. In the US, around two million adverse drug events occur each year among older adults in outpatient settings, often due to a lack of cross-specialist communication. With no central platform to link care teams, families are often required to act as medical coordinators. To address these challenges, is claimed to provide an online infrastructure for families to coordinate specialist care. An spokesperson said: "The healthcare system is not designed for the reality of ageing, where a single patient may need a cardiologist, a neurologist, and a physical therapist all at the same time. That lack of coordination leads to preventable crises. "We built this platform to fix that fragmentation. We are giving caregivers the tool they need to move from a state of constant crisis management to one of proactive, coordinated care." The platform offers a curated database of senior-care specialists, including orthopaedists, physical therapists and podiatrists for mobility; neurologists, ophthalmologists and audiologists for cognitive and sensory health. It also includes cardiologists, geriatricians and palliative care specialists for chronic conditions. "InfoAging launches care team finder platform in Florida for senior healthcare" was originally created and published by Hospital Management, a GlobalData owned brand. The information on this site has been included in good faith for general informational purposes only. It is not intended to amount to advice on which you should rely, and we give no representation, warranty or guarantee, whether express or implied as to its accuracy or completeness. You must obtain professional or specialist advice before taking, or refraining from, any action on the basis of the content on our site. Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
