Healthcare Roundup—Aurora Health Care agrees to pay $12M to settle kickback allegations

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Wisconsin-based Aurora Health Care Inc. will pay $12 million to settle allegations that it violated federal kickback and false claims laws.

According to the Justice Department, Aurora—which is part of Advocate Aurora Inc. and operates in Wisconsin, Illinois and the upper peninsula of Michigan—allegedly entered into compensation arrangements between 2008 and 2012 with two doctors "that were not commercially reasonable" and exceeded fair market value of the physicians' services.

They said Aurora took into account the physicians’ anticipated referrals. Aurora is accused of then submitting claims to Medicare and Medicaid for services ordered by those physicians. Those actions are allegedly in violation of the Stark Law, which blocks the government from paying for services ordered by physicians with improper financial relationships with entities to whom they refer patients, and the False Claims Act, which bars an entity from knowingly submitting such claims to the government for payment.

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“This $12 million settlement demonstrates how these violations have a significant and direct economic impact on the healthcare industry,” said FBI Special Agent in Charge Justin Tolomeo in a statement. “Our priority is to protect consumers and hold accountable those in the healthcare system who misuse the Medicare and Medicaid programs.”

The investigation that discovered the allegedly improper compensation arrangements resulted from a whistleblower lawsuit, and whistleblowers will recover a portion of the settlement. (Release)

2019 Marketplace enrollment statistics trailing those from last year

Open enrollment is quickly drawing to a close, and the latest data from the Centers for Medicare & Medicaid Services suggest that the number of people purchasing coverage on the federal marketplace is going to drop. 

Between Nov. 1 and Dec. 8 this year, nearly 550,000 fewer consumers bought coverage on compared to the same time frame last year. This includes about 271,000 fewer new customers and 274,000 fewer renewals.  

None of the 39 states that use the platform have seen more enrollees this year than last year. Open enrollment ends on Dec. 15. (Release

Teladoc sued for deceiving investors after report reveals CFO’s misconduct

Teladoc Health has been hit with a class-action lawsuit by shareholders accusing the company and its top executives of violating federal finance laws by hiding company information from investors.

The lawsuit, filed on Wednesday, comes on the heels of an investigative report by the Southern Investigative Reporting Foundation (SIRF) that detailed one senior executive’s sexual relationship with a subordinate that included bouts of insider trading.

According to that report, published earlier this month, Teladoc Chief Financial Officer and Chief Operating Officer Mark Hirschhorn, 54, engaged in an affair with 30-year-old Charece Griffin, who enrolled clinicians to the company’s network. But, according to SIRF, Griffin told colleagues she and Hirschhorn liked to trade company stocks together, with the CFO advising her on opportunities to sell.

lawsuit (PDF) filed by shareholder Jon Reiner in the U.S. District Court for the Southern District of New York heavily cites the SIRF report. The complaint alleges that the company, Hirschhorn and CEO Jason Gorevic “made material false and misleading statements,” failed to disclose Hirschhorn’s inappropriate relationship with a subordinate and failed to enforce its own policies prohibiting insider trading. (FierceHealthIT)

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