Tag Archives: prosecutors

US Prosecutors Charge Major Insurance Firms with Paying Kickbacks for Private Medicare Plans

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The Justice Department has charged three major health insurance companies with engaging in illegal kickback schemes totaling hundreds of millions of dollars over several years, involving payments to insurance brokers who guided individuals to private Medicare plans.

Federal prosecutors also alleged that two of these insurers colluded with brokers to discriminate against individuals with disabilities by hindering their enrollment in private Medicare plans, based on the belief that these plans would be costlier.

Around 12% of Medicare beneficiaries, who are disabled and under the age of 65, qualify for the federal insurance program. Their intricate health requirements often lead to high care costs.

According to a complaint initially filed by whistleblowers, the Department of Justice has joined the case against the nation’s largest health insurance company, previously known as Anthem. Humana is also implicated for allegedly funneling kickbacks to three large brokers—Ehealth, GoHealth, and SelectQuote—to boost enrollment in Medicare Advantage plans, which have also been tied to fraudulent activities.

A complaint filed in federal court in Boston claims that the kickback scheme spanned from at least 2016 to 2021, accusing Aetna and Humana of discrimination against individuals with disabilities.

Aetna, Elevance, GoHealth, and Humana have denied the allegations, although others have not responded to requests for comments.

This lawsuit is one of the first indications of the Trump administration’s scrutiny of certain Medicare Advantage plans, which face ongoing federal oversight. Critics, including lawmakers, have condemned these popular plans for potential overcharging the federal government through aggressive marketing strategies. Over half of all individuals enrolled in the federal program are covered by Medicare Advantage plans.

During the Senate confirmation hearing for Dr. Mehmet Oz, he assured concerned senators about the oversight of Medicare plans, promising a “new sheriff” to address excesses.

Brokers play a crucial role in assisting senior Americans in selecting private Medicare plans. However, the allegations suggest brokers have directed individuals to plans that offer the highest commissions instead of the best fit for their needs.

In recent years, small local brokerage firms have been overshadowed by large national organizations that employ numerous agents and utilize call centers and websites like those mentioned in the lawsuit. These companies increasingly depend on technology to help brokers identify the optimal plans for callers, facilitating the kind of steering described in the allegations.

The Biden administration implemented regulations last year aimed at reducing the commissions insurance companies can pay to brokers for patient enrollments. Recent Congressional testimonies and consumer complaints have indicated that insurers are offering bonuses to brokers for enrolling more individuals in specific plans, regardless of their actual needs. However, the lawsuit is still pending.

Regarding cases involving disabled individuals, federal prosecutors have stated: “The efforts to specifically exclude beneficiaries are even more ruthless given that their disabilities may render them less profitable for health insurance companies,” said attorney Leah B. Foy. “We will continue to investigate and prosecute the greed targeting these beneficiaries.”

Source: www.nytimes.com

Federal prosecutors seek major medical journals in response to ambiguous threat

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Federal prosecutors in Washington reached out to the New England Journal of Medicine with unsubstantiated inquiries that implied the journal, considered one of the most prestigious in the world, may be biased towards certain viewpoints and influenced by external pressures.

NEJM editor Dr. Eric Rubin described the letter as “blatantly threatening” in an interview with the New York Times.

Republican activist Edward Martin Jr., serving as interim U.S. attorney in Washington, sent similar letters to at least three journals. Martin has faced criticism for using his position to target opponents of the administration.

The letter accused the journal of taking sides in scientific debates and posed accusatory questions about bias and the selection of research articles.

Will they consider submissions from scientists with differing perspectives? How will they handle authors whose work they have published that may have misled readers? Are they transparent about the influence of supporters, funders, advertisers, etc.?

This news about the letter to NEJM was previously reported by Stat and Health News Outlet.

Martin also raised questions about the role of the National Institutes of Health, which funds some of the research published by the journal, and its involvement in the development of submitted articles.

Amanda Shanor, a First Amendment expert at the University of Pennsylvania, emphasized that information published in reputable medical journals like NEJM is widely protected by the Constitution.

She explained that journals have the same rights as newspapers in most cases, with the Constitution providing the strongest legal protection.

“There is no legal basis to suggest that medical journals are not afforded the strictest First Amendment protections,” she stated. “It seems to be an attempt to instill a sense of fear and censorship that impacts people’s freedom of expression. This raises constitutional concerns.”

It is unclear how many journals received these letters or the criteria Martin used to target publications. The U.S. Attorney’s Office in Washington did not respond to requests for comment.

“Our role is to assess and evaluate science in an impartial manner,” Dr. Rubin stated. The questions raised seem to insinuate biases in our operations – it is quite vague This introduces a threatening element. ”

Former editor of Science magazine, Jeremy Berg, believed the letter was an attempt to coerce journals into publishing papers aligning with the administration’s views on climate change and vaccines, even if the research quality is lacking.

National Health Secretary Robert F. Kennedy Jr. mentioned in an interview with the “Dr. Hyman Show” podcast last year that NEJM was involved in disseminating misinformation and distorting scientific facts.

Department of Health and Human Services spokesman Andrew Nixon declined to comment on Kennedy’s involvement in the letter.

Kennedy expressed his intention to possibly take legal action against medical journals under the Federal Anti-Corruption Act.

“I plan to file a lawsuit against you under general tort laws and the Assault Act,” he stated. “Unless you have a plan to demonstrate how you will begin publishing genuine scientific work, I will find a way to pursue legal action against you.”

Dr. Jay Bhattacharya, the new head of NIH, has criticized mainstream science journals and recently co-founded a new journal that offers alternative perspectives on Covid.

The UK-based Lancet showed support by editing Editor Skas’s response, calling it “an obvious attempt to intimidate and stifle editorial independence.”

“American science and medicine are being closely watched worldwide,” the editor stated.

One of Martin’s letters was directed at the journal Chest, a publication focused on technical research in areas like lung cancer and pneumonia. It was reported by The New York Times that at least two other publishers received similar letters.

These publishers chose not to speak publicly for fear of repercussions from the Trump administration.

Dr. Rubin also expressed concerns about potential political backlash. Science journals often rely on public funding indirectly, with universities using federal grants to pay for subscriptions.

“Are we concerned? Absolutely,” he said. “But we are committed to doing what is right.”

Martin gave the magazines until May 2nd to respond to his inquiries. NEJM has already issued a statement refuting the accusations made against their journal.

“We maintain strict peer review and editing processes to ensure the integrity and trustworthiness of published research,” the statement affirmed. “We uphold the editorial independence of medical journals and their inherent right to protect their freedom of expression.”

This is not NEJM’s first run-in with the Trump administration.

In 2020, the Journal dismissed an editor who criticized the president’s pandemic response. This marked the first time in its 208-year history that the Journal took a stance on a political figure.

Dr. Rubin speculated that Martin’s letter may be related to this editorial decision. While the Journal Chest did not publish on Trump’s first term, the connection was noted.

Source: www.nytimes.com

Prosecutors urged to step up efforts to combat revenge porn and protect victims from abusers depicted in images online

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The Crown Prosecutor’s Office is planning to update its guidance on “revenge porn” crimes to ensure that explicit photos of the victim are no longer allowed to be retained.

observer reported last month that the Magistrates’ Court did not order the removal of content related to Image-based abuse cases, and prosecutors did not request such action.

An examination of court records revealed that out of 98 cases, only three resulted in deprivation orders requiring offenders to surrender their devices and delete private photos and videos.

In one case, a man was accused by a magistrate of engaging in “deeply disturbing” behavior to emotionally intimidate the victim. Despite receiving a suspended sentence, no order was issued to have him surrender his device for deletion, leaving the police without the legal authority to do so.

These findings prompted outcry from activists, demanding immediate action and stating that the failure to act left victims “living in fear.” The CPS acknowledged the need for more action to prevent these images from being used to perpetrate further crimes.

The prosecutor’s guidance on communication crimes is currently being revised. The new guidelines, released this week, urge prosecutors to utilize deprivation orders more effectively and consistently.

Prosecutors are advised to consider implementing the order early in their case strategies to strip offenders of their devices promptly and foster a more uniform approach to device confiscation from suspects from the outset.

Campaigners welcomed the change as a positive step forward.

Elena Michael from the campaign group #notyourporn commended the guidance as a helpful step but emphasized the need for further actions to be taken.

She highlighted additional areas for improvement, such as addressing issues related to evidence collection and advocating for a more comprehensive investigation process.

Furthermore, she urged clarity on whether the guidance would extend to hard drives, cloud storage, and physical devices in addition to mobile phones.

Law professor Claire McGlyn praised the updated guidance as a positive development and a step towards progress, emphasizing the importance of addressing image-based sexual abuse cases more effectively.

The Judgment Council, responsible for issuing guidance to judges and magistrates, stated that they are monitoring the government’s new intimate image law proposal and will consider necessary adjustments to guidelines once it is enacted.

Source: www.theguardian.com