| Editor's Choice: Legal News | Bridgeport Hospital, part of Yale New Haven Health, is accused in a lawsuit of not staffing an overnight physician in an intensive care unit. It’s alleged that the remote care coordination caused delays that led to the death of 26-year-old Conor Hylton, who was experiencing emergency seizure-like symptoms. Bridgeport Hospital, part of Yale New Haven Health, is accused in a lawsuit of not staffing an overnight physician in an intensive care unit. It’s alleged that the remote care coordination caused delays that led to the death of 26-year-old Conor Hylton, who was experiencing emergency seizure-like symptoms. | | |
| A federal grand jury indicted Anar Rustamov, 38, of Azerbaijan on 14 counts of healthcare fraud. The complex conspiracy allegedly involved billing Medicare Advantage for medical equipment that providers never ordered. Rustamov is currently a fugitive from justice. A federal grand jury indicted Anar Rustamov, 38, of Azerbaijan on 14 counts of healthcare fraud. The complex conspiracy allegedly involved billing Medicare Advantage for medical equipment that providers never ordered. Rustamov is currently a fugitive from justice. | | |
| In total, 131 hospitals are acting as plaintiffs. They’re asking a court to throw out 2023 changes to the Disproportionate Share Hospital calculation that altered the way Medicare Advantage and Social Security income were factored into the risk-adjusted payments hospitals receive for caring for vulnerable patient populations. In total, 131 hospitals are acting as plaintiffs. They’re asking a court to throw out 2023 changes to the Disproportionate Share Hospital calculation that altered the way Medicare Advantage and Social Security income were factored into the risk-adjusted payments hospitals receive for caring for vulnerable patient populations. | | |
| On Tuesday, a judge formally rejected a motion by the company to have the case dismissed. Carelon Behavioral Health, a subsidiary of Elevance, is accused of publishing an inaccurate directory of providers for those seeking mental health services. On Tuesday, a judge formally rejected a motion by the company to have the case dismissed. Carelon Behavioral Health, a subsidiary of Elevance, is accused of publishing an inaccurate directory of providers for those seeking mental health services. | | |
| Ohio State University College of Medicine, Stanford University School of Medicine and UC San Diego School of Medicine all received letters this week where federal authorities are requesting details related to admissions, including standardized test scores, donor correspondence and more. The schools say they are already compliant with state and federal regulations. Ohio State University College of Medicine, Stanford University School of Medicine and UC San Diego School of Medicine all received letters this week where federal authorities are requesting details related to admissions, including standardized test scores, donor correspondence and more. The schools say they are already compliant with state and federal regulations. | | |
| In a complaint filed in federal court, the U.S. Department of Justice claims NewYork-Presbyterian Hospital uses its power of “scale, breadth and configuration” to control payer contracts, making it difficult for insurers to develop low-cost plans. The health system denies any wrongdoing. In a complaint filed in federal court, the U.S. Department of Justice claims NewYork-Presbyterian Hospital uses its power of “scale, breadth and configuration” to control payer contracts, making it difficult for insurers to develop low-cost plans. The health system denies any wrongdoing. | | |
| The Electronic Frontier Foundation, a nonprofit digital civil rights advocacy group, said it filed a Freedom of Information Act request seeking more information about the “WISeR” pilot program, which effectively adds a prior-authorization process to traditional Medicare in six states. To date, it’s received no response. The Electronic Frontier Foundation, a nonprofit digital civil rights advocacy group, said it filed a Freedom of Information Act request seeking more information about the “WISeR” pilot program, which effectively adds a prior-authorization process to traditional Medicare in six states. To date, it’s received no response. | | |
| It’s unclear why Tallahassee Memorial HealthCare dropped its lawsuit, but it did so with prejudice, meaning the hospital cannot refile. There are many unanswered questions surrounding the unusual case, including how common incidents like this are and whether or not the hospital can technically bill for the time the room was occupied. It’s unclear why Tallahassee Memorial HealthCare dropped its lawsuit, but it did so with prejudice, meaning the hospital cannot refile. There are many unanswered questions surrounding the unusual case, including how common incidents like this are and whether or not the hospital can technically bill for the time the room was occupied. | | |
| The U.S. Department of Justice said the insurer upcoded patient diagnoses to boost risk-adjusted payments it received from the Centers for Medicare & Medicaid Services. The company did not admit to wrongdoing, despite agreeing to the payout. The U.S. Department of Justice said the insurer upcoded patient diagnoses to boost risk-adjusted payments it received from the Centers for Medicare & Medicaid Services. The company did not admit to wrongdoing, despite agreeing to the payout. | | |
| Judge Brian Murphy with the U.S. District Court of Massachusetts sided with the American Academy of Pediatrics and other plaintiffs who challenged the authority of HHS Secretary Robert F. Kennedy Jr to effectively remove the Advisory Committee on Immunization Practices from the process put in place to make changes to CDC vaccine recommendations. Judge Brian Murphy with the U.S. District Court of Massachusetts sided with the American Academy of Pediatrics and other plaintiffs who challenged the authority of HHS Secretary Robert F. Kennedy Jr to effectively remove the Advisory Committee on Immunization Practices from the process put in place to make changes to CDC vaccine recommendations. | | |
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