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Case Notes
The United States Supreme Court recently denied certiorari and left standing an unpublished Second Circuit decision allowing a health plan to recoup overpayment of benefits by downcoding and withholding from the physician payment of benefits for services provided to other beneficiaries.
Medco False Claims Act Settlement Sets Parameters for Pharmacy Benefits Managers
On October 23, 2006, the United States Department of Justice entered into a widely anticipated $155 million settlement agreement with Medco Health Solutions, Inc. which contracted to provide pharmacy benefit management (“PBM”) services for federal employees and retirees and others. The settlement, including the parameters created by the numerous detailed allegations of illegal activities contained therein, along with the terms of an earlier settlement with the Attorneys General of twenty states, establishes standards for PBM organizations which have no specific regulatory framework.
Supreme Court Denies Certification in Healthcare Antitrust Case
On February 20, 2007, the U.S. Supreme Court declined to review a petition challenging a Seventh Circuit ruling that affirmed summary judgment dismissing all claims alleging violations of Sections 1 and 2 of the Sherman Antitrust Act. Kochert v. Greater Layfayette Health Services, Inc., et al., U.S., No. 06-822, cert. denied (Feb. 20, 2007). This case outlines the principles of antitrust standing and injury.
