“Even for a company as big as Anthem Inc., the nation’s largest marketer of Blue Cross Blue Shield insurance, paying a half-billion-dollar settlement might seem like a painful way to resolve litigation,” reports Greg Andrews and Indianapolis Business Journal Staff in The Indiana Lawyer.

“But some investment analysts and health care observers say changes to Blue Cross Blue Shield rules that are stipulated in the settlement are so favorable to Indianapolis-based Anthem’s growth prospects that they view the deal as a huge win for the company.”

“The settlement, struck last fall and awaiting final approval in an Alabama federal court, resolves lawsuits filed in 2012 by insurance customers alleging the Chicago-based Blue Cross Blue Shield Association and the nation’s 36 Blue Cross and Blue Shield insurers violated antitrust laws through practices that limited competition and caused higher prices. The total settlement is $2.7 billion, with Anthem shouldering $594 million.”

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“With a notably sharply worded opinion, the Fifth Circuit recently vacated over $4.3 million in penalties levied against the University of Texas M.D. Anderson Cancer Center (M.D. Anderson) by the Department of Health and Human Services (HHS) for a series of alleged HIPAA violations,” reports Dianne J. Bourque and Michelle L. Caton in Mintz’ Insights Center.

“The case, University of Texas M.D. Anderson Cancer Center vs. U.S. Department of Health and Human Services, stems from three separate incidents that occurred between 2012 and 2013. In two instances, M.D. Anderson workforce members lost unencrypted protected health information (PHI), while the third incident involved the theft of a faculty member’s laptop also containing unencrypted PHI. After investigating these occurrences, HHS fined M.D. Anderson a total of $4,348,000, which M.D. Anderson contested through the agency’s administrative review process. On review, both the administrative law judge (ALJ) and the Departmental Appeals Board upheld the penalties.”

“On appeal, the Fifth Circuit concluded that HHS’s civil monetary penalties order against M.D. Anderson was arbitrary, capricious, and contrary to law, vacating the penalties and pointedly criticizing the agency’s actions and arguments in this matter. The court identified “at least four independent reasons” for its conclusion.”

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“On August 24, 2020 in Ann Finch v. Covil Corp., 972 F.3d 507 (4th Cir. 2020), the Fourth Circuit Court of Appeals upheld a North Carolina federal district court’s decision, sustaining a $32.7 million verdict in favor of the plaintiff in an asbestos-related wrongful death lawsuit against insulation contractor Covil Corporation. On appeal, Covil argued that the district court erred in instructing the jury as to proximate cause and refused to reduce the damages award, however the three-judge panel found no fault with the district court’s jury instructions or its rationale for refusing to reduce the jury verdict,” write Deanielle Luisi and Tierra Jones in Husch Blackwell’s Toxic Tort Monitor.

“The $32.7 million verdict in Finch is reportedly the largest single-plaintiff verdict and the largest mesothelioma-related verdict in North Carolina history. Additionally, the verdict is four times larger than any other North Carolina mesothelioma verdict.”

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“The Department of Health and Human Services Office for Civil Rights reached a $200,000 civil monetary penalty and a corrective action plan with Banner Health, to resolve potential violations of the HIPAA Privacy Rule Right of Access standard,” reports Jessica Davis in Health IT Security’s HIPAA and Compliance News.

“The Arizona-based healthcare system is one of the largest in the US, with more than 30 hospitals and a range of primary care, urgent care, and specialty facilities. The settlement covers more than 74 covered entities included under the Banner Health umbrella.”

“Announced as an enforcement priority in 2019, the OCR RIght of Access Initiative is designed to support the right of patients to access their medical records in a requested format and in a timely fashion, for a reasonable fee. While required under HIPAA, data shows many providers fail to meet the privacy rule requirements.”

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“The HIPAA Safe Harbor bill amends the HITECH act to require the Department of Health and Human Services to incentivize best practice cybersecurity for meeting HIPAA requirements,” reports Jessica Davis in Health It Security’s News.

“The Senate unanimously passed the legislation without amendment on December 19.”

“The legislation directs HHS to take into account a covered entity’s or business associate’s use of industry-standard security practices within the course of 12 months, when investigating and undertaking HIPAA enforcement actions, or other regulatory purposes.”

Read the article to learn more.

“On December 10, 2020, the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) announced proposed changes to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule to support individuals’ engagement in their care, remove barriers to coordinated care, and reduce regulatory burdens on the health care industry,” writes Jennifer Guerrero in Buchalter’s Publications.

“Several of the proposals modify provisions related to individuals’ right of access to protected health information (“PHI”), including strengthening individuals’ rights to inspect their PHI in person (e.g., allowing individuals to take notes or use other personal resources to view and capture images of their PHI). Another change shortens covered entities’ required response time to no later than 15 calendar days (from the current 30 days) with the opportunity for an extension of no more than 15 calendar days (from the current 30-day extension).”

Read the article for other notable proposed changes.

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“UnitedHealth Group Inc. announced Friday its hire of Matthew Friedrich as chief legal officer, a role he will assume Jan. 11, as the managed health care and insurance company copes with the ongoing fallout from the coronavirus pandemic,” reports Brian Baxter in Bloomberg Law’s The United State Law Week.

“Friedrich, 54, is a former partner at Boies Schiller Flexner and Freshfields Bruckhaus Deringer who has spent the past three years as general counsel and chief corporate affairs officer at Cognizant Technology Solutions Corp., an information technology services provider and large federal government contractor.”

“He will succeed retiring UnitedHealth legal chief Marianne Short, 69, the first female managing partner at Dorsey & Whitney in Minneapolis. Short stepped down from the law firm in 2013 to take over as UnitedHealth’s top lawyer, replacing Richard Baer, now chief legal officer at Airbnb Inc.”

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“Purdue Pharma’s massive settlement over claims that it helped spark the opioid crisis is facing pushback in federal court, creating a potential stumbling block for the landmark deal,” reports Bloomberg in the Los Angeles Times’ Business.

“Purdue has agreed to plead guilty to three felonies and pay $8.3 billion to settle federal investigations of how it marketed the painkiller OxyContin. But the deal violates bankruptcy rules because it locks in details of Purdue’s future and forces the hand of other creditors, according to court papers filed by a group of U.S. states and bankruptcy professors.”

“States and cities suing Purdue have been in talks with the bankrupt pharmaceutical giant for months over how to settle thousands of opioid lawsuits. The settlement with the U.S. Department of Justice unveiled last month dictates that Purdue will be repurposed as a public trust after it emerges from bankruptcy, which creditors haven’t agreed to.”

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Assistant Chief Mark Begley was awarded a $1.84 million lawsuit settlement against the County of Kaua‘i and Kaua‘i Police Department, reports Jason Blasco in The Garden Island.

“Begley was put on paid administrative leave in March 2012 when he filed a stress-based worker’s compensation claim, citing a hostile work environment. He was reinstated in June 2019.”

“In 2016, Begley initiated a federal lawsuit against the county, KPD and several senior officers, claiming that the now-retired KPD Chief Darryl Perry and his successor, former Acting Chief Michael Contrades, harassed and retaliated against him for reporting allegations that another assistant chief acted inappropriately toward a subordinate female officer.”

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“Johnson & Johnson has been defending against claims its talc-based powders cause cancers for years, and, with a new ruling against the drugmaker in Missouri, it’s preparing to challenge a massive verdict at the U.S. Supreme Court,” reports Eric Sagonowsky in Fierce Pharma.

“After a Missouri appeals court this summer lowered a 2018 talc verdict against the drugmaker to $2.11 billion, J&J pledged to appeal to the state’s Supreme Court. That court has now refused to take up the appeal—and J&J says it’ll take its case higher.”

“But it’s far from certain to get a hearing at the U.S. Supreme Court, either. Of the 7,000 cases it’s asked to review each year, the high court takes up 100 to 150 of them, according to U.S. government figures.”

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“Doctor Shoaib Qureshi, Doctor Imran Mirza, Memphis Primary Care Specialists, Lunceford Family Health Center, and Getwell Family Medicine agreed to pay $341,690 to resolve allegations that they violated the False Claims Act by knowingly charging Medicare for services rendered by nurse practitioners at the higher reimbursement rate for physician services, the Justice Department announced today,” released the Department of Justice’s Office of Public Affairs.

“Medicare pays a higher rate for physician services than for non-physician services. Medicare will pay the higher physician rate for services rendered by non-physician providers if the services are ‘incident to’ the services of a physician. Such ‘incident to’ services, however, must be provided under the direct supervision of a physician. The United States alleged that, from 2015 to 2018, Doctor Qureshi, Doctor Mirza, and their clinics billed Medicare as though the physicians had provided the services in question, when in fact nurse practitioners had treated the patients without the supervision required by Medicare’s ‘incident to’ rules. Indeed, the government alleged that the services were rendered when the physicians were out of the office, including times when they were traveling out of state or abroad.”

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“Anthem is paying a substantial portion of Blues plans’ tentative antitrust settlement, which is estimated to be nearly $3 billion, executives said on a call with investors on Wednesday morning,” reports Paige Minemyer in Fierce Healthcare’s Payer.

“Anthem has penciled in $594 million for its contribution to the $2.7 billion settlement. The Blue Cross and Blue Shield Association reportedly agreed to the settlement in a lengthy class action suit late last month.”

“Anthem chief financial officer John Gallina called the settlement ‘pending’ during the earnings call, and said having a deal in the works ‘removes an uncertainty’ for the business around the ongoing litigation.”

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“The settlement resolves allegations that Merit Medical Systems engaged in a kickback scheme lasting more than six years to pay healthcare providers to induce use of its products in medical procedures performed on Medicare, Medicaid, and Tricare beneficiaries,” reports Clare Goldsberry in Plastics Today’s Medical News.

“Medical device maker Merit Medical Systems Inc. (MMSI) has agreed to pay $18 million to resolve allegations that it caused the submission of false claims to the Medicare, Medicaid, and Tricare programs by paying kickbacks to physicians and hospitals to induce the use of MMSI products.”

“The Anti-Kickback Statute prohibits offering or paying anything of value to induce the referral of items or services covered by Medicare, Medicaid, Tricare, and other federal healthcare programs.”

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“Connecticut Attorney General William Tong announced Monday that the generic opioid manufacturer Mallinckrodt has agreed to a $1.6 billion settlement to resolve a host of lawsuits that arose in response to tens of thousands of deadly opioid overdoses nationwide fueled, in part, by prescription drugs,” reports Nicholas Rondinone in Hartford Courant’s Breaking News.

“Exactly how the money will be distributed remains under negotiation, Tong said, but the settlement and pressures from the COVID-19 pandemic led the drug maker, one of the largest supplier of generic opioids, to file bankruptcy this week.”

“In the settlement framework, Mallinckrodt has agreed to pay the money into a trust, which will go toward response to the opioid epidemic and help address individual claims against the company for its role in the crisis, Tong’s office said.”

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“Mayo Clinic Jacksonville and a proposed class of 371 patients it treated for motor vehicle accident injuries received preliminary approval of a settlement involving claims the health-care provider overcharged them, a federal court in Florida said,” reports Mary Anne Pazanowski in Bloomberg Law’s The United States Law Week.

“The class was reasonably defined and met all the prerequisites for class certification, the U.S. District Court for the Middle District of Florida said Tuesday.”

“Additionally, the total settlement amount of just over $1 million appeared to be adequate, except for the amounts allocated to an incentive fee for the named plaintiff and for class counsel’s attorneys’ fees, the court said.”

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“Johnson & Johnson will pay out over $100 million to settle more than 1000 lawsuits that claim the pharmaceutical giant’s baby powder caused cancer,” reports Daniel Cassady in Forbes’ Breaking News.

“The settlement is the first in four years of litigation and nearly 20,000 lawsuits that allege Johnson & Johnson’s baby powder and talc products caused cancer due to asbestos contamination, according to the report.”

“In 2018, a New York Times investigation found Johnson & Johnson had for at least 50 years been aware of possible asbestos contamination in its talc products without telling consumers. Test results detected no greater than 0.00002% of “chrysotile asbestos” in the talc products that were recalled in October. Thousands of lawsuits have been filed against the company by people who claim to have developed mesothelioma and ovarian cancer, both of which are linked to asbestos exposure, after using the company’s talc products.”

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“A federal grand jury has indicted Stephen L. Snyder, age 72, of Miami Beach, Florida, on the federal charges of attempted extortion and interstate travel and use of an interstate facility to carry on unlawful activity, also known as the Travel Act. Snyder was the senior partner at a Baltimore-based law firm specializing in plaintiff-side medical malpractice litigation,” released in the The United States Attorney’s Office District of Maryland.

According to the indictment “between January and October 2018, Snyder attempted to obtain $25 million from the University of Maryland Medical System (UMMS) for himself, separate and apart from any claim by one of his clients, by using threats of economic and reputational harm to UMMS and its organ transplant program. Specifically, the indictment alleges that Snyder threatened that if UMMS did not pay him $25 million, Snyder would launch a public relations campaign against UMMS that alleged, among other things, that UMMS transplanted diseased organs into unsophisticated patients without informing them of the quality of the organs they were receiving in order to generate revenue. According to the indictment, Snyder told UMMS officials that the campaign would include: a front-page article in the Baltimore Sun; other national news stories; a press conference; advertisements on the Internet, including one that would run every time someone accessed the UMMS transplant site; and at least two videos Snyder produced and would air if his demand for a $25 million payment were not met.”

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“Three individuals were charged today in connection with a multi-million dollar Medicare fraud scheme, bringing the total number of defendants to six,” reports the Department of Justice in The United States Attorney’s Office District of Massachusetts.

The three “were each charged by Information with one count of receiving kickbacks in connection with a federal health care program.” Two “were also charged by Information with violating the HIPAA statute.”

The papers claim defendants “sold Medicare patients’ personal and medical data … worked with foreign call centers to contact Medicare patients to ask if they were interested in durable medical equipment (DME) such as arm, back, knee and shoulder braces ‘at little to no cost.’ The call centers collected demographic and insurance information from Medicare patients.” The defendants “received more than $1.6 million… for the patient data.”

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“Attorney General Kathy Jennings announced Monday that Delaware has joined the United States, twenty-seven other states, and the District of Columbia to settle allegations against Novartis Pharmaceuticals Corporation. Delaware’s settlement amount of $94,450.99 will go to the Division of Medicaid and Medicaid Assistance within the Delaware Department of Health and Social Services.” was reported on Delaware.gov’s Department of Justice Press Releases.

“The settlement resolves allegations that from January 2002 to November 2011, Novartis paid kickbacks to doctors to prescribe Lotrel, Valturna, Starlix, Tekamlo, Diovan HCT, Tekturna HCT, and Exforge HCT, and that between January 2010 and November 2011, Novartis did so for Exforge, Diovan, Tekturna. It was alleged in court documents that Novartis systemically paid doctors to speak about certain drugs at sham events, with a veneer of education applied in an attempt to avoid the law, and covered the costs of lavish meals and entertainment for attendee doctors, to induce doctors to write prescriptions for these Novartis drugs. Novartis admitted aspects of the scheme in a stipulation filed in federal court in connection with the settlement, to include admissions concerning excessive meal and alcohol spending, minimal medical discussions at Novartis’s events, and repeat attendance. This conduct violated the Federal False Claims Act, the Federal Anti-Kickback Statute, the Delaware False Claims and Reporting Act, and the Delaware Anti-Kickback Statute resulting in the submission of false claims to DMMA within DHSS.”

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“Bayer AG has settled thousands of U.S. Roundup weed killer lawsuits as part of an $11 billion settlement, reaching deals with the only lawyers who took cases to trial over allegations the herbicide caused cancer,” reports Tom Hals in Insurance Journal.

“In letters filed with U.S. District Court in San Francisco late on Monday, three lawyers said they had reached binding settlements.”

“The agreements covered 15,000 lawsuits, according to attorneys familiar with the talks, bringing the resolved cases to about 45,000. Bayer has estimated it faces 125,000 filed and un-filed claims over Roundup.”

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