California Attorney General Rob Bonta on Tuesday announced a settlement with L.A.-based U.S. Healthworks, a nationwide chain of occupational and urgent care clinics. The $7.7 million settlement resolves allegations that USHW knowingly kept millions of dollars from the State of California in unclaimed property, in violation of the Unclaimed Property Law (UPL) and the California False Claims Act (CFCA). The unclaimed property in question included patient balances due to overpayment. As part of the settlement, USHW must hand over unclaimed property totaling $1.5 million to the State Controller's Office. At times, urgent care centers carry patient balances due to overpayment. This happens when an insurance payment is more than was anticipated after patients pay out-of-pocket costs. While the urgent care should issue a refund in these situations, sometimes refund checks mailed to patients are returned or are never cashed. In March 2022, Attorney General Bonta filed a complaint alleging that USHW possessed unclaimed property as early as 2001, and did not file mandated reports with the State of California until 2018 after being notified of the Attorney General's investigation.
Millions of Americans are trapped in a 'ghost network.' As some of those people have discovered, the providers listed in an insurer's network have either retired or died. Many other providers have stopped accepting insurance — often because the companies made it excessively difficult for them to do so. Some just aren't taking new patients. Insurers are often slow to remove them from directories, if they do so at all. It adds up to a bait and switch by insurance companies that leads customers to believe there are more options for care than actually exist.
North Carolina officials had been quietly laboring for months on an ambitious plan to tackle the state's mammoth medical debt problem when Gov. Roy Cooper stepped before cameras in July to announce the initiative. But as Cooper stood by the stairs of the executive mansion and called for "freeing people from medical debt," the future of his administration's work hung in the balance. Negotiations were fraying between the state and the powerful hospital industry over the plan to make hospitals relieve patient debt or lose billions of dollars of public funding tied to the state's Medicaid expansion. The federal government hadn't signed off on North Carolina's plan, putting funding at risk. And not a single hospital official stood with the governor that day. In exchange for federal money, hospitals would wipe out billions of dollars of patient debt and adopt new standards to shield patients from crippling bills. "It's a model that the rest of the country could adopt," said Jared Walker, founder of Dollar For, a national nonprofit that helps patients get financial aid from hospitals.
Chicago-based Oak Street Health has agreed to pay $60 million to settle allegations that it paid kickbacks to insurance agents in exchange for their help recruiting patients. DOJ alleged that from 2020 to 2022, Oak Street had a program under which third-party insurance agents contacted seniors to market Oak Street to them. Agents would then refer interested seniors to an Oak Street employee through a three-way phone call. Oak Street would then typically pay the agents $200 per beneficiary they referred. The government alleged that Oak Street submitted false claims to Medicare because of violations of the Anti-Kickback Statute. CVS Health, which acquired Oak Street in 2023, noted in a statement Thursday that in the settlement, "There was no admission of — and we expressly deny — any wrongdoing."
Mercy, one of the largest health systems in Missouri, is threatening to stop accepting Anthem insurance unless an agreement on how much the insurer reimburses hospitals for care is reached by the end of the year. Chesterfield-based Mercy, which operates dozens of hospitals and hundreds of other outpatient locations in the region, has announced it intends to move out of the insurer's network in January if Anthem does not agree to a new contract. The contract sets the amount of money the insurer pays hospitals for surgeries, checkups and the thousands of other services the health system provides.
Walgreens has agreed to pay $106 million to settle lawsuits that alleged the pharmacy chain submitted false payment claims with government healthcare programs for prescriptions that were never dispensed. The settlement announced on Friday resolves lawsuits filed in New Mexico, Texas and Florida on behalf of three people who had worked in Walgreens' pharmacy operation. The pharmacy chain was accused of submitting false payment claims to Medicare, Medicaid and other federal healthcare programs between 2009 and 2020 for prescriptions that were processed but never picked up.