Health

Centene Announces Deal to Acquire Competing Provider Wellcare

Health insurer Centene on Wednesday announced an agreement to buy Wellcare, another insurer, in a $15.3 billion deal, The New York Times reports. The move will position Centene to become the largest provider for government-sponsored health care plans in the United States, including through Medicare Advantage and state insurance marketplaces. The deal is expected to close by June 30 next year.

read more »

Purdue Pharma, Oklahoma Reach Settlement, Praised by AG Slatery

Oklahoma has reached a landmark settlement with Purdue Pharma regarding its role in the opioid crisis, The Washington Post reports. This is the first such settlement in the more than 1,600 lawsuits faced by the drug maker, including the case in Tennessee where Knox County Circuit Court Judge Kristi M. Davis struck down Purdue’s motion for dismissal. Tennessee Attorney General Herbert Slatery released a statement praising the action and reaffirmed the state’s commitment to holding Purdue and other manufacturers accountable for possible violations of the Tennessee Consumer Protection Act. In the Oklahoma settlement, Purdue will pay $102.5 million to establish a new foundation for addiction treatment and research, provide $20 million worth of treatment drugs and cover about $60 million in litigation costs.
read more »

TDCI Recoups Millions for Tennessee Policyholders

The Tennessee Department of Commerce & Insurance’s (TDCI) Consumer Insurance Services Section announced that it has recouped $3.2 million for Tennessee insurance policyholders who were errantly denied claims and other related issues, the Overton County News reports. The agency received 2,041 complaints or queries, mostly related to denials, delays, problems with adjusters, settlement offers and out-of-network benefits. TDCI Commissioner Julie Mix McPeak encourages consumers with concerns regarding their policy or denial contact the agency through its website.

read more »

Pain Management Conglomerate with Tennessee Clinics Facing Several Lawsuits

A pain management conglomerate with clinics in Tennessee, North Carolina and South Carolina that was raided late last year by the FBI is now facing several lawsuits, The Charlotte Observer reports. Investigators say that the Pain Management Associates of the Carolinas liberally dispensed unnecessary opioids to patients without proper evaluation, with a former employee going further, accusing the company of completing the evaluations as a “mere formality” and that it would see patients for just a couple minutes, then bill Medicare at a higher rate. The company also goes by FirstChoice Healthcare and Oaktree Medical Centre.

read more »

Health Care Giant Receives $1.7 Billion Refund Despite Paying no Federal Tax in 2018

Health Care Service Corp. — the parent company for Blue Cross Blue Shield health plans in Illinois, Montana, New Mexico, Oklahoma and Texas — received a $1.7 billion tax refund despite paying no federal taxes in 2018, Axios reports. The company showed $4.1 billion profit on $35.9 billion of revenue in 2018 vs. $1.3 billion net profit on $32.6 billion of revenue in 2017, for which it paid about $467 million in federal taxes. The company credited the surplus to the repeal of the corporate alternative minimum tax as part of the Tax Cut and Jobs Act of 2017.

read more »

State AGs, Women's Health Advocates Will Fight Changes to Title X

State attorneys general and women's health advocates are pushing back at the Trump Administration’s rules for the federal family planning program, Title X, but will likely face an uphill battle, NPR reports. The U.S. Supreme Court in 1991 upheld similar measures in the case of Rust v. Sullivan, which proponents uphold as proof that the rules are constitutional. The crux of the argument surrounds removing Planned Parenthood from the Title X program, an enduring pursuit of abortion opponents. Planned Parenthood has not said whether it will sue, however, several states and the ACLU intend to file lawsuits challenging the regulations.

read more »

Knox Co. Judge Rejects Purdue Pharma Request to Dismiss Opioid Lawsuit

Knox County Circuit Judge Kristi Davis rejected a motion by Purdue Pharma to dismiss a lawsuit filed last year by Tennessee Attorney General Herbert Slatery III on behalf of taxpayers accusing the company of playing an integral role in the state’s opioid epidemic, The Knoxville News Sentinel reports. Purdue maintains that it has no liability regarding the epidemic, saying the drug which sparked the lawsuit, Oxycontin, was approved by the Food and Drug Administration and that it complied with all FDA labeling requirements. Davis ruled the state isn’t suing Purdue for labeling and selling the drug as authorized by the FDA, stating in her opinion “the court finds that Purdue’s argument is based upon a mischaracterization of the state’s complaint, which is not grounded in the content of the medication labels but rather the conduct of Purdue and its pharmaceutical sales representatives.” Purdue maintains the blame falls solely on opioid addicts and over-prescribing doctors, not its drug.

read more »

Tennessee Republicans Push for Medicaid Block Grants

Tennessee lawmakers on Wednesday advanced a measure that seeks a fixed amount of federal block grants to provide health care to lower-income and disabled residents, The Chattanooga Times Free Press reports. Under current law, Medicaid reimburses the state a fixed percentage on its Medicaid costs, with Tennessee receiving approximately $7.5 billion in federal money for its $12.1 billion Medicaid program, which state Republicans say gives little incentive to keep expenses under control because no state pays more than half the total cost, whereas the new bill — HB1280/SB1428 — would “convert the federal share of all medical assistance funding for this state into an allotment that is tailored to meet the needs of this state and that is indexed for inflation and population growth.” Though lawmakers remain optimistic regarding the advancement of the legislation, it is unclear whether Gov. Bill Lee will support the measure, given his opposition to Medicaid expansion and insistence on finding an alternative option to aid the estimated 167,000 Tennesseans without health coverage.

read more »

Ballad Health Provides New Details Regarding NICU Plans in East Tennessee

Ballad Health has issued a new response to the Tennessee Department of Health regarding questions about its proposed changes for the neonatal intensive care unit (NICU) in two east Tennessee hospitals, the Johnson City Press reports. In its response, Ballad provided specific details and statistics requested by former Health Commissioner John Dreyzehner. Under the proposed plan, newborns requiring Level III NICU services will be transported to Niswonger Children’s Hospital in Johnson City instead of current Level III hospital Holston Valley Medical Center, which will be downgraded to a Level I provider.

read more »

Tenet Healthcare Seeking Attorneys in Nashville, Dallas Offices

Tenet Healthcare — one of the nation’s leading investor-owned healthcare companies — is seeking several experienced health care attorneys to join its legal team based in Nashville or Dallas. The open positions are:
 
Senior Counsel Tenet Physician Resources
Will be the legal counsel for the Tenet Physician Resources (TPR) team to develop and implement the physician employment process and practice operations and will advise TPR on Stark, Anti-kickback, and other regulations impacting physician employment, practice acquisitions and practice operations, as well as, be responsible for Physician Employment Agreements, Professional Services Agreements, Asset Purchase Agreements, and related space and equipment lease negotiation and drafting.
 
Senior Regulatory Counsel
Will be responsible for understanding the daily operations of Tenet’s acute care hospitals and their affiliates and will provide oversight in the review of compliance matters, statutory and regulatory issues, fraud and abuse considerations, government investigations, HIPAA, EMTALA, reimbursement matters and conducting internal investigations.
 
Senior Counsel, Hospital Operations
This is a unique “in house” professional opportunity to function as the General Counsel to a portfolio of Tenet’s acute care hospitals and provide legal advice to the company’s hospital CEOs and executive teams on a wide variety of matters related to hospital operations including the review and analysis of all contractual arrangements/agreements between hospitals and other parties for compliance for Stark, anti-kickback and other fraud and abuse laws, EMTALA, HIPPA, antitrust laws and any other applicable regulatory requirements.
 
Interested and qualified candidates can contact Tenet’s Director Executive Search Christina Carter at christina1.carter@tenethealth.com or 202-329-5244.
 
read more »