On and on and on............
HEALTH MAINTENANCE ORGANIZATIONS (HMO)
United Health - The largest HMO/Healthcare insurer. Three of their subsidiaries just received subpoenas from NY Attorney General Andrew Cuomo, who is investigating their billing practices and various other forms of fraud against the government. - Cuomo to Sue UnitedHealth Over What’s Reasonable Payment - - Cuomo to Sue UnitedHealth, Probe Reimbursement Policy - Attorney General Andrew Cuomo issued subpoenas to 16 insurers in his probe into reimbursement practices. He’s alleged that the HMOs have cheated customers out of hundreds of millions of dollars.
WellCare - A relatively small HMO, but 100% of their business comes from Medicaid and Medicare programs. My opinion on the 200 federal agent raid on their Tampa facility? An exercise to gather information that will help federal and state governments investigate this entire corrupt industry.
Other HMOs include: Aetna, Cigna, WellPoint, and Humana.
GROUP PURCHASING ORGANIZATIONS (GPO) - These folks negotiate prices on products for the institutional sector, but they also have considerable exposure to drugs destined for the retail class of trade. They negotiate prices for institutional buyers, but much of the products they buy are diverted straight to retail pharmacies or to the grey market, where they earn huge profit margins by defrauding various government healthcare programs. All sorts of rebate, fee, and bundling agreements can be used by companies in this sector to defraud the government and increase their own profits, and the profits of their commercial sector customers.
GPOs include companies like Novation, Broadlane, Consorta, Innovatix, and GeriMed.
April 22, 2008
Categories: Antitrust, Capitalism, Pharma Litigation . . Author: Ima Misfit
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