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The Days of Full COVID Coverage Are Over; Insurers Are Restoring Deductibles and Co-Pays, Leaving Patients with Big Bills

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Jamie Azar left a rehab hospital in Tennessee this week with the help of a walker after spending the entire month of August in the ICU and on a ventilator. She had received a shot of the Johnson & Johnson vaccine in mid-July but tested positive for the coronavirus within 11 days and nearly died, The Washington Post reported. Now Azar is facing thousands of dollars in medical expenses that she can’t afford. In 2020, as the pandemic took hold, U.S. health insurance companies declared they would cover 100% of the costs for COVID treatment, waiving co-pays and expensive deductibles for hospital stays that frequently range into the hundreds of thousands of dollars. But this year, most insurers have reinstated co-pays and deductibles for COVID patients, in many cases even before vaccines became widely available. The companies imposed the costs as industry profits remained strong or grew in 2020, with insurers paying out less to cover elective procedures that hospitals suspended during the crisis. Now the financial burden of COVID is falling unevenly on patients across the country, varying widely by health care plan and geography.If you live in Vermont or New Mexico, state mandates require insurance companies to cover 100% of treatment. But most Americans with COVID are now exposed to the uncertainty, confusion and expense of business-as-usual medical billing and insurance practices — joining those with cancer, diabetes and other serious, costly illnesses. (Insurers continue to waive costs associated with vaccinations and testing, a pandemic benefit the federal government requires.) A widow with no children, Azar is part of the unlucky majority. Her experience is a sign of what to expect if COVID, as most scientists fear, becomes endemic: a permanent, regular health threat. The carrier for her employee health insurance, UnitedHealthcare, reinstated patient cost-sharing Jan. 31. That means, because she got sick months later, she could be on the hook for $5,500 in deductibles, co-pays and out-of-network charges this year, including her ICU stay, according to estimates by her family. They anticipate she could face another $5,500 in uncovered expenses next year as her recovery continues.

Connecticut to Appeal Purdue Pharma Bankruptcy Plan: AG Tong

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Connecticut's attorney general filed formal notice that the state will appeal OxyContin maker Purdue Pharma's bankruptcy plan, FOX61 reported. It is a controversial and unprecedented decision that purports to extinguish Connecticut’s claims against the company and the Sackler family, according to Attorney General William Tong's office. “The Sacklers are not bankrupt," Tong said. "We cannot allow our bankruptcy laws to be abused and misused as a loophole for the rich and powerful to avoid justice and accountability." He continued: "This decision was an unprecedented and unacceptable overreach by the bankruptcy court. Connecticut has filed notice that we will appeal and will continue to fight on behalf of the victims and families of the opioid epidemic until we see justice." Earlier this month, a federal bankruptcy judge gave conditional approval to the $10 billion plan submitted by Purdue Pharma. Under the settlement reached with creditors including individual victims and thousands of state and local governments, the Sackler family would have to give up ownership of the company and contribute $4.5 billion but will be freed from any future lawsuits over opioids. However, Tong said the Sacklers are worth multiple times that amount. "By the time they are finished paying this settlement, the Sacklers will be wealthier than they were when they started," he added. Tong joined eight other attorneys' general filing objections in the U.S. Bankruptcy Court for the Southern District of New York. Click here to view the press release.

How One of the Largest Nursing Home Chains in Florida Could Avoid Nearly All of $256 Million Fraud Judgment

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The Justice Department and a medical whistleblower have tentatively agreed to settle a $256 million civil fraud judgment against a large nursing home chain for $4.5 million, according to court documents filed on Monday in U.S. Bankruptcy Court in Delaware, the Washington Post reported. Entities operating under Consulate Health Care, a chain based in Florida tied to private equity company Formation Capital, filed for chapter 11 protection in March. The sixth-largest nursing home chain in the country with 140 facilities from the Mid-Atlantic to the Gulf Coast, it said that it did not have the resources to pay the large False Claims Act judgment against it. A federal civil jury in 2017, in a decision later upheld by the U.S. Court of Appeals, concluded that nursing homes now owned by Consulate defrauded taxpayers through inflated billings for rehabilitation services for residents. The penalty was the culmination of a whistleblower case brought in 2011 against an earlier owner of Consulate’s nursing homes by Angela Ruckh, a nurse who worked at two of the chain’s nursing homes. In the proposed bankruptcy settlement, the United States will receive $3.375 million and Ruckh will get $1.125 million, according to a copy of the proposed agreement filed in court by Consulate’s lawyers. Consulate’s operations division, headquartered in Maitland, Fla., and two of its nursing homes will be sold to another entity that also is related to Consulate, according to public records and court documents.

Bankruptcy Judge Approves Purdue Pharma's $7 Million Executive Bonus Plan

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Purdue Pharma, the bankrupt maker of the OxyContin painkiller, yesterday obtained court approval to pay up to $7.1 million in incentive payments for five top executives if they meet certain goals, despite opposition from U.S. government lawyers, Reuters reported. Bankruptcy Judge Robert Drain in White Plains, N.Y., signed off on the executive incentive plan at the conclusion of a virtual hearing. His ruling comes about two weeks after he said that he will approve Purdue’s reorganization plan, which rests on a $10 billion settlement of opioid-related litigation. The judge said repeatedly during yesterday’s hearing that he does not consider the incentive payments “bonuses” because even if they are paid out in full, the executives would still only fall in the middle of the total compensation range for executives at major pharmaceutical companies. The incentive payments, he said, are essentially part of the executives’ salaries, he added. “No doubt my ruling will be construed by some as authorizing large bonuses to executives. I do not believe that is in fact the case here,” he added. “A bonus is something you get over and above median compensation.” He rejected an argument from the U.S. Department of Justice’s bankruptcy watchdog, the U.S. Trustee, that Purdue failed to show that the 2021 incentive plan is truly incentivizing, rather than a bonus for executives who are simply showing up to work.

Endo Settles New York Opioid Lawsuit For $50 Million While Seeking Broader Deal

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Endo International PLC agreed to pay $50 million to settle with New York state and county authorities over the opioid crisis as the drugmaker pursues a broader resolution to its opioid-related liabilities, WSJ Pro Bankruptcy reported. The settlement with New York state, Suffolk County and Nassau County officials removes Endo from a continuing trial over allegations that it and other drugmakers contributed to widespread opioid addiction. Jayne Conroy, lead counsel for Suffolk County, said the settlement with Endo “ensures funding will be made available for critical abatement programs in a more expedited fashion.” Under the settlement terms, Suffolk and Nassau counties will receive $13.85 million each, while $22.3 million will go to the New York state attorney general’s office. Endo still faces nearly 3,000 other legal cases pending against it from states, counties, cities and Native American tribes over opioids, which the company said Thursday it is focused on resolving. The company, which has operations in Malvern, Pa., but is domiciled in Ireland following a 2014 corporate tax inversion, also said it is exploring strategic alternatives and “may seek to implement one or more of those alternatives” if it can’t reach a broad global deal to settle the opioid litigation.

Receiver Liquidating Property of Stow-Glen Retirement Village

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When Stow-Glen Retirement Village notified the state of Ohio it was closing in July, it automatically defaulted on its loan with Northwest Bank, triggering a legal agreement to appoint a receiver, the Akron Beacon Journal reported. Marc P. Gertz, an Akron lawyer who specializes in bankruptcy law, said it doesn’t appear Stow-Glen will file for bankruptcy because a court-appointed receiver is already working to liquidate Stow-Glen’s assets. The receiver, appointed by a Summit County Common Pleas judge, will sell Stow-Glen’s real estate, auction off or sell off its property — everything from beds to art on the walls — and collect outstanding bills owed to Stow-Glen. All of that money will go to Northwest Bank, which said in court records that it is out about $4.2 million on its loan deal with Stow-Glen. Stow Mayor John Pribonic said there’s keen interest in the Stow-Glen property, which is in a prime location near shopping and other services about halfway between Stow’s town center and Kent. He said about 15 developers have reached out to the city asking about the property.

Theranos Founder Elizabeth Holmes’s Trial Set to Begin

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Prosecutors and defense lawyers are scheduled to deliver opening statements Wednesday in the highly anticipated criminal trial of Theranos Inc. founder Elizabeth Holmes, who faces federal charges of defrauding patients and investors with claims of revolutionary blood-testing technology, the Wall Street Journal reported. The opening remarks in court will be the first opportunity for the former chief executive’s lawyers and the prosecutors with the U.S. attorney’s office in the Northern District of California to influence the jury in a trial expected to last more than three months. Ms. Holmes rose to fame as a Stanford University dropout who founded what appeared to be a cutting-edge health company, which was valued at more than $9 billion before imploding over questions about its technology. Prosecutors will lay out their case against Ms. Holmes, whom they have accused of fraudulently touting Theranos’s blood-testing machines as being able to test accurately and reliably for a range of health conditions using a few drops of blood from a finger prick. As reported in 2015, Theranos only used its finger-stick machines to analyze a small percentage of its blood tests and instead routinely used commercial analyzers and blood drawn from an arm vein. To win a conviction, government lawyers must convince the jury that Ms. Holmes intended to commit fraud, not simply that the company ran into problems living up to its promises. Ms. Holmes’s attorneys have said the once-lauded Silicon Valley executive believed in what Theranos set out to accomplish and didn’t defraud anyone. She has pleaded not guilty to 10 counts of wire fraud and two counts of conspiracy to commit wire fraud.

Former NFL Players Plead Guilty to Healthcare Fraud

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Clinton Portis was among three former National Football League players who have pleaded guilty for their roles in a nationwide scheme to defraud a healthcare program for retired NFL players, the U.S. Justice Department said yesterday, Reuters reported. Portis, a former running back who was drafted by Denver in 2002 and spent the bulk of his career with Washington, D.C., faces a maximum penalty of 10 years in prison. He is scheduled to be sentenced on Jan. 6. The alleged scheme targeted the Gene Upshaw NFL Player Health Reimbursement Account Plan, which was set up in 2006 to help retired players cover medical expenses. According to court documents, Portis caused the submission of false and fraudulent claims to the plan on his behalf over a two-month period, obtaining $99,264 in benefits for medical equipment that was not actually provided. Portis, who earned two Pro Bowl selections during an NFL career that spanned 2002-2010, and former wide receiver Tamarick Vanover pleaded guilty on Friday, two days after their trial resulted in a hung jury. Former NFL linebacker Robert McCune, the third defendant in that trial, pleaded guilty on the second day of the trial. Portis was one of 10 former NFL players charged in December 2019 with allegedly defrauding the a healthcare program of more than $3.4 million by filing false claims for hyperbaric oxygen chambers and other expensive medical equipment.

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Legal Shield for Purdue Pharma Owners Is at Heart of Appeals

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The end of the Purdue Pharma bankruptcy case has left a bitter taste for those who wanted to see more accountability for members of the Sackler family, the Associated Press reported. The Sacklers will give up ownership of the company, go out of the international opioid business and pay $4.5 billion in cash and charitable assets under the settlement. But they also will escape any future liability over the nation’s addiction and overdose crisis as part of the deal that was given preliminary approval this week by a federal bankruptcy judge. Some state attorneys general and one federal government office are planning appeals. The question at the heart of their arguments: Is it appropriate for members of a wealthy family that did not file for bankruptcy themselves to get such a broad protection? Attorneys and victim advocates involved in a case that included lawsuits from some 3,000 governments and other entities said the members of the Sackler family who have owned Purdue played instrumental roles in overseeing the company and marketing OxyContin. Critics say the company’s best-selling prescription painkiller helped fuel the opioid crisis in the U.S.