Earlier this month, this website wondered aloud, “Why the hell is Joe Biden’s Justice Department defending Donald Trump?” The question arose from a bizarre, troubling pattern of late in which the DOJ, currently lead by Attorney General Merrick Garland, has gone to bat for the ex-president. In May, for example, the department filed a motion seeking to appeal a federal judge’s ruling that the agency had to release the memo that Bill Barr used to help clear Trump of obstruction in the Russia probe. Weeks later, Garland’s attorneys continued a push started by Barr to defend Trump in a defamation lawsuit brought by author E. Jean Carroll, with Barr’s DOJ arguing that Trump was acting in his capacity as POTUS when he responded to her rape allegations by saying: “Number one, she’s not my type. Number two, it never happened,” and then also: “[She’s] totally lying. I don’t know anything about her. I know nothing about this woman. I know nothing about her. She is—it’s just a terrible thing that people can make statements like that.” Obviously this was disturbing for a number of reasons, not the least of which being that (1) a federal judge already ruled last October that Trump was not, in fact, acting “within the scope of his employment” when he went after Carroll, leaving the DOJ under no obligation whatsoever to defend the guy (2) he is now a private citizen who claims to be very rich and can afford his own lawyers and (3) as Carroll’s attorney put it, such a position by the government “would give federal officials free license to cover up private sexual misconduct by publicly brutalizing any woman who has the courage to come forward.” Also, the department may have painted itself into a corner wherein it might have to defend Trump against lawsuits accusing him of inciting the January 6 attack on the Capitol.
According to a number of constitutional scholars and lawyers who spoke to Reuters, the DOJ’s decision to claim in the Carroll case that presidents enjoy basically boundless immunity for their comments in office will likely have “profound implications” for a number of ongoing suits, including ones concerning the insurrection Trump caused.
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Attorney Joseph Sellers, who is representing U.S. Representative Bennie Thompson in his suit against the ex-president, told reporters Peter Eisler and Joseph Tanfani, “I don’t think anyone would think it’s within the scope of the president’s legitimate duties to encourage people to interfere with the functioning of another branch of government. He was promoting an insurrection and a riot.”
Ultimate Fighting Championship has long dominated the world of mixed martial arts. But UFC’s effort to swallow up competitors has triggered a class action by fighters who claim it’s abusing its power. Now a key court victory threatens the organization’s very business model. Bloomberg’s Josh Eidelson investigates.
The antitrust class action discussed in this Bloomberg video is Cung Le, et al v. Zuffa, LLC, d/b/a Ultimate Fighting Championship and UFC, Case No. 2:15-cv-01045 (D. Nev.) Cohen Milstein is Co-Lead Counsel in this case.
A proposed class-action lawsuit led by the $20.7 billion Arkansas Teacher Retirement System, Little Rock, against Goldman Sachs Group hit a roadblock Monday when the U.S. Supreme Court ordered the 2nd U.S. Circuit Court of Appeals in New York to reconsider allowing shareholders to pursue a class action over alleged misrepresentations made during the subprime mortgage crisis about its ethical principles and internal controls over conflicts of interest.
The 2011 lawsuit stemmed from Goldman Sachs’ Abacus collateralized debt obligation, a subprime mortgage-based financial instrument assembled with the help of hedge fund Paulson & Co. Goldman Sachs’ contrary bet against the CDO was not disclosed to investors, leading to its $550 million settlement with the Securities and Exchange Commission in 2010.
The Supreme Court’s 8-to-1 decision agreed with Goldman Sachs’ argument that its issuer statements may have been too generic to affect Goldman’s stock price. The appeals court will now reconsider the question.
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The Supreme Court did agree with the appeals court that defendants, not shareholder plaintiffs, bear the burden of persuasion to prove a lack of price impact.
It is an important victory for investors, said Laura Posner, a partner with Cohen Milstein, who wrote an amicus brief for securities administrators supporting the plaintiffs. “The decision confirms that defendants bear the burden to demonstrate by a preponderance of evidence a lack of the price impact, including in cases where the price maintenance theory is alleged.”
Managed-care company establishes $1.1 billion reserve related to talks with other states.
Centene Corp. said it settled claims from Ohio and Mississippi related to its pharmacy-benefit billing practices, and it is setting aside $1.1 billion to resolve similar issues with other states.
The big managed-care company said it will pay about $88 million to Ohio and $55 million to Mississippi. Ohio’s attorney general, Dave Yost, sued the company in March, alleging that it had misled the state’s Medicaid program about its pharmacy-related costs, resulting in overpayments by the state.
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Mississippi’s attorney general and auditor investigated similar issues, though the state hadn’t sued Centene. They said in a press release that the settlement “resolves allegations of overpayments as a part of Mississippi’s Medicaid program.”
Centene, which is based in St. Louis, said it admitted no fault in the settlements and denies any liability for the practices that the states examined. The company said that the issues that the states focused on occurred “primarily during 2017 and 2018” and it has since restructured its pharmacy benefits operations.
Several states are investigating pharmacy benefit managers’ disclosure and billing practices, generally focused on their Medicaid and state-employee plans. Pharmacy benefit managers typically work for employers and health plans, managing drug benefits and negotiating pricing with pharmaceutical companies and drugstores. They often have many lines of business that involve state governments, including handling the drug benefits of state employees and working with managed-care companies that administer Medicaid benefits.
The stakes for Centene are particularly high in the Medicaid-related probes because managing Medicaid coverage is a core business for the company. Ohio had deferred a decision about whether Centene could participate in its new Medicaid contracts for 2022, due to the litigation. The settlement is “reopening the door for [Centene] to receive a contract award” in Ohio, wrote Scott Fidel, an analyst at Stephens Inc.
Centene said it was negotiating with two law firms, Liston & Deas and Cohen Milstein, that are working with other states “in an effort to bring final resolution to these concerns.”
Centene says it has set aside $1.1 billion to cover settlements from similar lawsuits in other states.
Shares of Centene were lower on Monday after the healthcare insurer agreed to pay settlements to Ohio and Mississippi over claims that it inflated pharmacy costs.
Centene, the country’s largest seller of Medicaid health plans, will pay $88 million to Ohio and $55 million to Mississippi in restitution. The company denies liability for the practices for which it is settling.
Medicaid provides health coverage to eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by the states and funded jointly by the states and the federal government.
The company also said it reserved $1.1 billion to resolve similar claims in other states.
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A number of state attorneys general have brought litigation against the company related to the Envolve Pharmacy Solutions pharmacy-benefits subsidiary.
In March, Ohio sued, alleging the company’s Ohio subsidiary used a network of pharmacy benefits subcontractors to misrepresent pharmacy costs, leading to millions of dollars of overpayments by the Ohio Department of Medicaid.
America’s 24th-largest corporation Centene has agreed to pay Ohio $88 million to settle a lawsuit accusing the health-care giant of making off with millions of dollars meant to help the state’s most vulnerable residents.
The unusually rapid surrender by Centene on a lawsuit filed barely three months ago shows the stakes to even a $111 billion company with about 70,000 employees of Ohio’s hardline action — especially a freeze on the St. Louis-based outfit’s participation in a $20 billion contract to provide managed care services to 3.2 million Medicaid recipients.
The deal is expected to be announced Monday morning at a press conference by Ohio Attorney General Dave Yost.
Centene also has reached a separate $55 million settlement with Mississippi. The company does not admit fault in any of the deals, which are centered on its pharmacy benefit manager subsidiary, Envolve Pharmacy Solutions.
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Centene is the subject of similar investigations in other states. Authorities in Arkansas, Georgia, Kansas, New Mexico and several other states are looking into filing legal action against the conglomerate. America’s largest managed-care provider provides services to some 25 million across the country.
Centene has set aside another $1.1 billion for the other states, many of whom are represented by the same Mississippi law firm as Ohio, Liston & Deas and Cohen Milstein.
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The defendants in the Ohio suit are Centene and two wholly owned subsidiaries: Envolve Pharmacy Solutions and Buckeye Community Health Plan, which has provided managed-care services since 2004 for Ohio’s Medicaid program. Also involved is another offshoot of Centene, Health Net Pharmacy Solutions.
Centene Corp. has agreed to pay Ohio $88.3 million and Mississippi $55 million to end claims that its pharmacy benefits manager, Envolve Pharmacy Solutions Inc., overbilled state agencies, while setting aside an additional $1.1 billion, the health care company announced Monday.
Centene said in a filing with the U.S. Securities and Exchange Commission that no-fault agreements with the attorneys general resolve an Ohio state court suit and allegations from the state of Mississippi related to “services provided by Envolve” and its “structure and processes” in 2017 and 2018.
The company also announced that it has recorded a reserve estimate of $1.1 billion “related to this issue.”
Ohio Attorney General Dave Yost sued Centene and its subsidiary Buckeye Health Plan in March, accusing its pharmacy benefit manager of overbilling the Ohio Department of Medicaid for drugs.
Yost said Monday that the deal is the first, and largest, secured by a state against a PBM.
“Centene used sophisticated moves to bill unearned dollars — moves known only at the top levels of health care companies,” Yost said in a release. “It has taken a huge effort by my team to untangle this scheme — and now that we know how it works, the alarm bells should be ringing for anyone using similar tactics.”
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Ohio is represented by Don W. Davis Jr. of Brennan Manna & Diamond LLC, David Nutt of David Nutt & Associates PC, W. Lawrence Deas and William Liston of Liston & Deas PLLC, and Steven J. Toll and Christina D. Saler of Cohen Milstein Sellers & Toll PLLC.
Centene Corp. agreed to pay settlements to Ohio and Mississippi to resolve claims that it inflated pharmacy costs, and the health insurer reserved $1.1 billion to resolve similar claims in other states.
Centene, the country’s largest seller of Medicaid health plans, will pay $88 million to Ohio and $55 million to Mississippi, while denying any liability for the practices leading to the settlement, the company said Monday in a statement.
Ohio’s attorney general sued Centene in March, alleging that the company used a web of affiliated contractors to overcharge the state for the cost of medications provided to Medicaid beneficiaries. That litigation will be dismissed as part of the settlement, Centene said.
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PBMs negotiate discounts with drug suppliers and administer pharmacy networks for health plans. But the complexity of the arrangements has led to scrutiny of the business in recent years, as employers and states seek more transparency around prescription costs.
After investigating the state’s Medicaid pharmacy benefits expenses for years, Ohio recently restructured the way it contracts for PBM services.
Authorities in several other states, including Arkansas and Kansas, are investigating PBM practices and working with some of the outside attorneys involved in the Ohio lawsuit, according to public records.
Centene said it had reserved an additional $1.1 billion related to this issue and was in talks with plaintiffs led by the law firms Liston & Deas and Cohen Milstein to resolve similar concerns in other states.
Centene Corp. has agreed to pay Ohio $88.3 million to settle a lawsuit alleging the pharmacy benefit manager overbilled the state’s Medicaid department for pharmacy services it provided, the state’s top lawyer announced Monday.
Republican Attorney General Dave Yost said the settlement is the first and largest in the nation secured by a state attorney general against a pharmacy benefit manager. PBMs are third-party companies that manage health care plans, including Medicaid, which serves 2.9 million Ohioans.
Yost’s suit alleged Centene and its subsidiary, Buckeye Health Plan, conspired to misrepresent the costs of pharmacy services it provided Ohio, which included the prices of prescription drugs.
The attorney general said state investigators uncovered a sophisticated scheme to bill unearned dollars known only at the top levels of health care companies. Yost alleges a series of contract breaches, including double-billing, failing to disclose drug discounts that affected prescription costs and artificially inflating fees.
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Talks continue with a plaintiffs’ group “in an effort to bring final resolution to these concerns in other affected states,” the company said.
Investors in Tivity Health Inc. have asked a federal judge in Nashville to approve a $7.5 million settlement deal that would end claims that the health improvement company concealed that one of its most important customers, United Healthcare Inc., was developing a program that would compete with one of Tivity’s flagship offerings.
In a brief filed Thursday, lead plaintiff the Oklahoma Firefighters Pension and Retirement System asked U.S. District Judge Chief Judge Waverly D. Crenshaw Jr. for an initial nod on the multimillion dollar deal, noting that the agreement was struck as the matter was “only weeks from trial.”
Given the settlement’s substantial value and the risks inherent in bringing this complex securities class action to trial and possibly appeal, the settlement represents an excellent result for class members,” the investors told Judge Crenshaw.
Tivity investor Eric Weiner launched the action in November 2017. The latest version of the claims alleges that Tivity and three of its executives hid from the public that United Healthcare was developing a fitness program called Optum Fitness Advantage for Medicare patients that is much like Tivity’s SilverSneakers fitness program.
The investors allege that Tivity continued to represent that its relationship with United was fine as United was building out its Optum program, despite the fact that revenue from United made up 10% of Tivity’s total revenues and that a program like Optum could hurt Tivity’s chances of locking down a new contract with United.
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The investors are represented by Steven J. Toll, Daniel S. Sommers, Joshua C. Handelsman, Christina D. Saler and Jessica (Ji Eun) Kim of Cohen Milstein Sellers & Toll PLLC and J. Gerard Stranch IV and Benjamin A. Gastel of Branstetter Stranch & Jennings PLLC.