California has launched an investigation of Aetna, the nation’s third largest health insurance provider, after former medical director Dr. Jay Ken Iinuma admitted to denying care without reviewing patients’ records. The investigation, which is being led by California Insurance Commissioner Dave Jones, began after Dr. Iinuma stated in deposition that he relied on recommendations from nurses when deciding whether to approve or deny care, rather than reviewing medication records. Fortune
A report being compiled by the Intelligence Community Inspector General’s office on whistleblower retaliation within American intelligence agencies has been halted. The Daily Beast reports that investigators looked into 190 cases of alleged retaliation within six agencies, and found that agencies were failing to protect intelligence workers who report waste, fraud, abuse, or criminality internally. However, the new acting head of the office, Wayne Stone, ordered the investigation to be halted after he discovered that one of the inspectors was a whistleblower in the middle of a federal lawsuit against the CIA.
The DOJ has settled two False Claims Act lawsuits with hospice company Horizons Hospice, LLC and its owner and Chief Executive Officer John C. Rezk for $1.24 million for fraudulently billing Medicare and Medicaid for hospice care for patients that did not qualify for hospice. One of the whistleblower lawsuits was filed in 2012 by a former nurse at the company’s Pittsburgh location, and the other lawsuit was filed in 2013 by two former certified nursing assistants.
Julian Craig, the former chief medical officer of United Medical Center in D.C., has filed a lawsuit against the hospital and its management consultants, according to The Washington Post. Craig’s lawsuit accuses the hospital and its consultants of “malfeasance affecting patient health and safety” and “submission of fraudulent statements to Medicare and Medicaid.” Additionally, Craig asserts that he was fired from his position in retaliation for raising issues with the facility at a public hearing.
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