Payer Roundup—Appeals court dismisses Cigna fraud case

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A federal court upheld an earlier ruling that Cigna did not commit fraud, and other healthcare news from around the web. (Cigna)

Appeals court dismisses Cigna fraud case

A federal appeals court affirmed a lower-court ruling, Singh v. Cigna Corp., to dismiss a fraud lawsuit against Cigna for allegedly misleading shareholders about complying with Medicare regulations. The court ruled that Cigna’s statement about its Medicare subsidiary HealthSpring can’t be considered fraud because it was tentative and generic. 

“We conclude that a reasonable investor would not rely on the challenged statements as representations of regulatory compliance. Accordingly, we affirm,” the court stated in its opinion. 

While Circuit Judge Jose A. Cabranes called the action “corporate mismanagement,” it does not fall under the jurisdiction of “securities fraud.” (Justia)

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Medicaid block grant passes Tennessee House committee

For the second time in a few short weeks, a bill to change how Tennessee could use federal money for healthcare received approval in the House Insurance Committee.

The bill would require the state’s administration to meet with federal officials to request a block grant for TennCare, the state’s Medicaid program.

The block grant is aimed at giving the state greater flexibility on how it spends health insurance money. Although Democrats have tried to amend the proposal to get assurance of Medicare for some of the state’s children and elderly populations, none of those amendments were accepted.

Now bills HB 1280 and SB 1428 will be sent to the House finance committee before they are taken up in a Senate committee. (Tennessean)

Northwell’s in-home visits saves Medicare $2.4M

Northwell has piloted a program known as House Calls as part of a Medicare experiment to see if healthcare providers can save money by bringing primary care into patients’ homes.

The program this year enrolled 15,000 patients, up from 10,000 last year, and is available for Medicare beneficiaries with two or more chronic conditions that require daily help. Plus, enrollees must have had a hospital admission and rehab stay within the past 12 months. 

Northwell is one of 12 participant providers nationwide and in its third year, the company lowered its spending by 21%, saving Medicare $2.4 million. (Crain’s)

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Centene announced another five states have approved its pending $17B merger with WellCare, bringing total number of approvals to 24.