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On March 8, 2017, the U.S. District Court for the District of Connecticut (the “Connecticut Court”) ruled, in Connecticut General Life Insurance Company v. True View Surgery Center One, LP, that Connecticut General Life Insurance Company (“Cigna”) was barred from pursuing recoupment from True View and other affiliated surgery centers (collectively, the “Surgery Centers”) for reported overpayments attributable to the Surgery Centers’ alleged fee-forgiving billing practices. Cigna served as a health benefits insurer and/or a third-party claims administrator for 316 h...

The Justice Department has joined a California whistleblower's lawsuit that accuses insurance giant UnitedHealth Group of fraud in its popular Medicare Advantage health plans.

Justice officials filed legal papers to intervene in the suit, first brought by whistleblower James Swoben in 2009, on Friday in federal court in Los Angeles. On Monday, they sought a court order to combine Swoben's case with that of another whistleblower.

Swoben has accused the insurer of "gaming" the Medicare Advantage payment system by "making patients look sicker than they are," said his at...

The DC District Court cited damaging market ownership and considerably large anti-competitive implications as basis for the Cigna-Anthem merger block.

The full opinion of United States District Court for the District of Columbia blocking Anthem’s acquisition of Cigna became publicly available earlier this week and provides details into the court’s decision.

In the memorandum opinion, Judge Amy Berman Jackson based the bulk of her decision on the effects of the Anthem-Cigna merger on market competition. In particular, the judge keyed in on the example of the insurance...

Hospitals and physician groups across the country are beefing up merit pay for quality and patient satisfaction in their physician compensation plans. But Geisinger Health System is doing something radically different.

The 12-hospital system based in Danville, Pa., did away with physician bonuses altogether this summer and put all of its 1,600 employed doctors on a straight salary.

Geisinger also made the decision to pay each physician at or above the national average whether in primary care or a specialty. “We don't have below-average doctors so we don't pay any...

The Consumer Financial Protection Bureau (CFPB) today ordered Nationstar Mortgage LLC to pay a $1.75 million civil penalty for violating the Home Mortgage Disclosure Act (HMDA) by consistently failing to report accurate data about mortgage transactions for 2012 through 2014. Today’s action is the largest HMDA civil penalty imposed by the Bureau to date, which stems from Nationstar’s market size, the substantial magnitude of its errors, and its history of previous violations. In fact, Nationstar had been on notice since 2011 of HMDA compliance problems. In addition...

California has one the nation’s lowest number of hospital emergency rooms per capita, and Bay Area legislators are calling this shortage a crisis, as the number of people who need urgent care services keeps growing. They are pushing for a bill that would require non-profit hospitals to obtain approval from the state Attorney General and hold at least one public hearing before closing their emergency departments.

In February, California State Senator Nancy Skinner, who represents the 9th District covering both Richmond and Oakland, introduced Senate Bill 687, designe...

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