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Health Net Fails in Acquiring PeaceHealth; Now Being Ordered by Court to Clarify Status

The health care provider PeaceHealth still maintains that it will not be part of Health Net’s network and its affiliate of Trillium Community Health Plan.

Overview

 The United States District Judge Michael McShane has ordered two health care providers, namely Health Net and Trillium Community Health Plan to make clear that a separate health care provider by the name of PeaceHealth will definitely not be a part of former’s in-network system, according to a news report article posted by The Register-Guard.

PeaceHealth is a health care company that operates in Lane County and is one of the biggest providers in the said location. In 2019, it filed a lawsuit against both Trillium Community Health Plan and its current affiliate Health Net Health Plan of Oregon. The main focus of the said lawsuit is due to the false advertising of the plaintiff’s relationship to both defendants, wherein it states that it has terminated its working relationship with them a few months ago before the lawsuit was filed in court.

Additional Details of The Lawsuit

 Judge McShane has issued a temporary restraining order against both Trillium and Health Net and ordered both companies to put immediate notices in their websites that make a clear message about their issue with PeaceHealth. The message should contain that PeaceHealth would clearly not be part of either defendant’s in-network for their Medicare Advantage patients starting the following year of 2020.

Do take note that before the said issue between the three companies is that PeaceHealth had long-standing agreements with both companies (Trillium and Health Net) wherein PeaceHealth will provide in-network hospital and doctor’s care for their Medicare Advantage patients during that time, wherein it started in 2004 with Health Net and in 2012 with Trillium respectively.

Unfortunately, those long-standing agreements broke down after the accusations of PeaceHealth in regards to the fraudulent misinformation that they have terminated both agreements, but instead PeaceHealth insists that it was both Health Net and Trillium who cut ties with them, not the other way around as suggested by the fraudulent misinformation being spread out by the two defendants.

A Possible Misunderstanding (Or Not)?

 Even though PeaceHealth was indeed going to terminate their in-network connection with the two defendants, it was going to happen instead on the first day of the following year, January 1, 2020.

PeaceHealth has made sure that their intention was well-received by both companies and in April 2019, the management of PeaceHealth has provided both of the companies’ management of official documentation of its intention to its long-standing agreements to each company in the following year. The said documentation also stated that massive changes will happen in affected locations, such as the hospitals located in Cottage Grove, Eugene, and Springfield locations, along with its group medical offices that locally serves each are mentioned.

However, as early as the 15th of October 2019, both companies have started to provide false information that PeaceHealth would still be part of either companies’ in-network and will still continue to provide hospital and doctors care to Medicare Advantage patients who are enrolled to either one of them.

Obviously, the management of PeaceHealth was infuriated to hear such fraudulent misinformation being given out to patients, in which they filed a lawsuit against both companies as a result.

In response to the action done by PeaceHealth, both companies have stated that the action of the plaintiff was both “unnecessary and improper”, and by doing so ceased any representation of a 2020 in-network pact with them well before a final meeting that was supposed to be held on the 8th of October, 2019.

The two defendants also accused PeaceHealth of an “abrupt termination of a long-standing relationship” between them that resulted in such a scenario between the three entities, in which the defendants believed that it could have been avoided if not for the actions of PeaceHealth.

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Doctors and Their Patients in Los Angeles Unite Against Health Net Over Denying Claims

Joining forces in order to Health Net, doctors from Los Angeles and two patients will now file a lawsuit against one of Centene Corporation’s known subsidiaries.

Overview

In order to be able to sue its target, a Los Angeles group representing a number of doctors have joined forces with two patients on suing Health Net for the accusations of it denying claims solely based on the insurer’s definition of “medical necessity”, according to a news article report posted by Reuters.

Lawsuit Details

The original lawsuit was filed in the Los Angeles Superior Court office in 2012, accusing the defendant Health Net of unfair and unlawful business practices. The aim of the lawsuit is to prevent Health Net and other similar companies from using the excuse of “medical necessity” as a way for them to deny medical assistance.

It has been also added that the health insurance company has denied the claims of the patient members due to it “being expensive”, which was confirmed by Rocky Delgadillo, the chief executive of Los Angeles County Medical Association.

Delgadillo has added that this kind of lawsuit is groundbreaking in the medical insurance industry, wherein he stated that this kind of issue shows that companies like Health Net and its parent company Centene Corporation will prioritize profits ahead of its customers, regardless of their current situation.

He added that the actions of Health Net in the said issue show that it is dictating on what medical care to provide to its members. The decision of which medical treatment is necessary for a patient and which one will cover it should be done by a doctor and not by a businessman, he said.

Response of Health Net

As a response to the accusations being thrown at them, the management of Health Net gave a statement in regards to it, saying that the current medical care today is a complex system, wherein there would be different medical opinions as to what constitutes as necessary medical care.

They’ve added that they have followed the guidelines when it comes to medical care, which has been established by the state of California’s two regulators, namely the Department of Managed Health Care (MHC) and the Department of Insurance, respectively.

Plaintiff’s Statements Over The Issue

To provide evidence and statement against Health Net, one of the plaintiffs of the said lawsuit by the name of Robert Mendoza, a 59-year old resident from Monrovia living in Los Angeles. Unfortunately for him, he was diagnosed with a rare type of prostate cancer. His doctor told him that he needs a specialized form of surgery, as cancer he had was very rare, as it can only occur within 60 worldwide.

In regards to the issue, he stated that he was forced to raise $30,000 from his funds meant to be used for paying income taxes and some from her wife’s life insurance policy since Health Net denied the claims of Mendoza.

It looks like prostate cancer (and its variants) is not a “necessary medical care” to them, apparently. Mendoza added that he felt that he was deceived by Health Net when his claims weren’t approved by their management, since he was a long-time member of the said company, starting from 1990. After his surgery that he paid out from his pocket and with some assistance from her wife’s life insurance policy, Mendoza was cancer-free a year later.

Another Plaintiff by the name of Kalana Penner has also given out a statement in regards to Health Net’s lack of action and care when it comes to its own patients who are in need of using their own plans & services. In Penner’s case, her request for a permanent device that can help her cope with her debilitating back, neck, and head pain was declined by Health Net. However, that decision was reversed in 2011 after the California Department of Insurance ruled out that Penner’s request should be covered.

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Former Competitors to Now Allies: Centene Corporation Acquires Health Net for $6.8 Billion

Now turn allies, Centene Corporation and its new subsidiary Health Net will aim to become the dominant health insurance company in the health care industry.

Overview

Once known rivals in the health care industry, both Centene Corporation and Health Net shocked and surprised their competitors and customers alike as the former bought out the latter through a lucrative $6.8 billion acquisition deal that took place in 2015, according to a news article report posted by The New York Times.

However, the said acquisition was not purely bells and whistles as Centene Corporation also got the debts of Health Net when it was still a separate company on its own. Now that it became a subsidiary of the larger Centene Corporation, the parent company would bear the debts of its newly acquired subsidiary, which others have started to question the worthiness of the said acquisition.

The Acquisition Details and Miscellaneous

Thanks to the acquisition of its former rival Health Net, Centene Corporation is now one of the biggest health care providers in the United States. The said acquisition created a company with more than 10 million members, along with an estimated revenue of $37 billion each year, starting from the year where the acquisition was fully completed.

Additionally, it would naturally give Centene Corporation an edge over the marketplace against its competitor’s thanks to its now wide reach. It would also expand Centene’s scale over the whole health care industry as a result.

Before the completion of the acquisition, the market share value of Health Net was $78.57 per share, wherein it represented a 21% premium to its closing price before it was fully acquired. However, the said deal wasn’t without its own catch as Centene Corporation got Health Net’s debt of $500 million by default.

Centene Corporation’s chairman, presiden, and CEO Michael F. Neidorff has stated his pleasure of having Health Net aboard their ranks in a state he has given. He added that the agreement that his company and Health Net made would create a positive value for both companies that have been merged together within a system. He ended his statement that holders from both Centene and Health Net will also benefit from the merger, as they will be able to serve them better with enhanced services.

The acquisition deal was subjected to both regulatory and shareholder approval and was completed in early 2016.

Things That Would Happen Next After The Acquisition

On the side of Health Net, iots former separate shareholders had received $28.25 in cash and 0.622 of a Centene share for each Health Net share they held previously before the merger. That would be the normal for them under the terms of the said acquisition.

Meanwhile, the shareholders of Centene will own about 71 percent of the combined company as a result. While the previous individual shareholders of Health Net would now own the remaining 29 percent after the completion of the merger between the two companies.

Now that Health Net has been absorbed into the system of Centene Corporation, Neidoff would be the de facto chairman, president, and CEO of both companies. The main headquarters for both companies would be based in St. Louis, while on Health Net side, the separate lower management will be still able to keep their previous office location in California.

The president and chief executive of Health Net, Jay M. Gellert, has assisted in the said merger to make the process more smoother and quicker. The whole merging process would be completed via existing cash and debt, according to the management of Centene.

Do take note that Health Net was still serving more than 6 million patient members by providing managed health care services through their products and insurance plans. They are able to do those via both company health plans and government programs like Medicare and Medicaid.

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Health Net Denied To Cover Medical Necessary Treatments

When you are a healthcare professional, you can witness different scenarios and multiple complaints about how incompetent those giant health insurance companies are in the United States. Having medical insurance here in California is neither necessary nor required; according to them, it will save you shortly when seeking medical attention. But it’s far from what happened to these two people who suffered because of Health Net Inc. Two Doctors from Los Angeles joined the two patients to file lawsuits for denying claims or denying claims based on the insurer’s definition of “medical necessity.” Health Net Inc. illegally denied patients medical treatments even though physicians had ordered them. There are medical rules and conditions on how to level the situation of patients if it is necessary or not. 

There’s a law here in California where insurers are allowed to cover. Los Angeles County Superior Court claims Health Net violated the law by refusing to pay for two patients’ treatments. Health Net is being unfair to everyone and runs unlawful business practices. The managed care plan operates mainly in the western United States and has 2.3 million members in California. March 2011 Robert Mendoza, a 59 years old man, was diagnosed with an aggressive and rare form of prostate cancer, and his doctor urged immediate treatment.

Mendoza’s doctor. Advised a minimally advised they have robotic-assisted surgery that Health Net was willing to cover. According to Mendoza, he needs to raise $30,000, which is out of his pocket. Health Net denied his request for coverage. With the help of USC’s Norris Cancer Hospital, they undergo Mendoza for a second opinion and his doctor. They have recommended more extraordinary because of the progressive nature of his advanced on. 

For the second time around, Health Net denied the treatment as not being medically necessary. The reason why Mendoza uses his own money and proceeds from his wife’s life insurance policy to pay for surgery to survive. He said Health Net has declined to reimburse him. “It’s had a dramatic financial impact on the whole family,” said Mendoza, and until now, Mendoza is paying more e than a thousand dollars a month in premiums. See how evil Health Net Inc. is. 

Their members need they choose to deny its coverage and focus only on their profit. For ten years, 33 years mother and student KalanaPenner suffered from a nerve condition that caused chronic back, neck, and head pain. Kalana’s neurosurgeon recommended she undergo “occipital nerve stimulation.”

The year 2011 after the medical review of Health Net’s denial and successful shea surgery soon after. According to Penner, not all consumers have a strong personality and resources to pursue an appeal. 

“I lost some of my life to this stalling by the insurance company,” she said. After her successful surgery, Health Net turned down his coverage. 

With the help of two lawyers Shernoff and Rocky Delgadillo, who have a history of suing insurers over alleged abuses? These two attorneys sued Health Net and other insurers for canceling consumers’ insurance policies after the patients became sick and filed expensive medical claims. After I heard those stories, I lost hope for the future, everyone got weak, and we were required to have medical insurance because we badly needed it to help us in the future. 

However, this kind of Health Insurance was abused and took advantage of people; they wanted a considerable profit to fulfill their pockets. Profit over lives and those big CEO still have the guts to build unworthy organizations. I feel sad for those who can’t afford it and have a big chance of suffering shortly because health insurance companies like Health Net will never give them help.

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Health Net Fails in Acquiring PeaceHealth; Now Being Ordered by Court to Clarify Status

The health care provider PeaceHealth still maintains that it will not be part of Health Net’s network and its affiliate of Trillium Community Health Plan.

Overview

The United States District Judge Michael McShane has ordered two health care providers, namely Health Net and Trillium Community Health Plan to make clear that a separate health care provider by the name of PeaceHealth will definitely not be a part of former’s in-network system, according to a news report article posted by The Register-Guard.

PeaceHealth is a health care company that operates in Lane County and is one of the biggest providers in the said location. In 2019, it filed a lawsuit against both Trillium Community Health Plan and its current affiliate Health Net Health Plan of Oregon. The main focus of the said lawsuit is due to the false advertising of the plaintiff’s relationship to both defendants, wherein it states that it has terminated its working relationship with them a few months ago before the lawsuit was filed in court.

Additional Details of The Lawsuit

Judge McShane has issued a temporary restraining order against both Trillium and Health Net and ordered both companies to put immediate notices in their websites that make a clear message about their issue with PeaceHealth. The message should contain that PeaceHealth would clearly not be part of either defendant’s in-network for their Medicare Advantage patients starting the following year of 2020.

Do take note that before the said issue between the three companies is that PeaceHealth had long-standing agreements with both companies (Trillium and Health Net) wherein PeaceHealth will provide in-network hospital and doctor’s care for their Medicare Advantage patients during that time, wherein it started in 2004 with Health Net and in 2012 with Trillium respectively.

Unfortunately, those long-standing agreements broke down after the accusations of PeaceHealth in regards to the fraudulent misinformation that they have terminated both agreements, but instead PeaceHealth insists that it was both Health Net and Trillium who cut ties with them, not the other way around as suggested by the fraudulent misinformation being spread out by the two defendants.

A Possible Misunderstanding (Or Not)?

Even though PeaceHealth was indeed going to terminate their in-network connection with the two defendants, it was going to happen instead on the first day of the following year, January 1, 2020.

PeaceHealth has made sure that their intention was well-received by both companies and in April 2019, the management of PeaceHealth has provided both of the companies’ management of official documentation of its intention to its long-standing agreements to each company in the following year. The said documentation also stated that massive changes will happen in affected locations, such as the hospitals located in Cottage Grove, Eugene, and Springfield locations, along with its group medical offices that locally serves each are mentioned.

However, as early as the 15th of October 2019, both companies have started to provide false information that PeaceHealth would still be part of either companies’ in-network and will still continue to provide hospital and doctors care to Medicare Advantage patients who are enrolled to either one of them.

Obviously, the management of PeaceHealth was infuriated to hear such fraudulent misinformation being given out to patients, in which they filed a lawsuit against both companies as a result.

In response to the action done by PeaceHealth, both companies have stated that the action of the plaintiff was both “unnecessary and improper”, and by doing so ceased any representation of a 2020 in-network pact with them well before a final meeting that was supposed to be held on the 8th of October, 2019.

The two defendants also accused PeaceHealth of an “abrupt termination of a long-standing relationship” between them that resulted in such a scenario between the three entities, in which the defendants believed that it could have been avoided if not for the actions of PeaceHealth.

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Health Net Federal Services Pays over $97M for Overstated Billings to the VA

Health Net Federal Services has paid $97,237,391 to resolve duplicate and inflated claims submitted to the Department of Veterans Affairs, according to Acting U.S. Attorney Phillip A. Talbert.

Health Net inked a $5.05 billion deal with the Veterans Affairs in 2013 as part of the Patient-Centered Community Care initiative, which provided private health care to veterans when VA facilities couldn’t provide it on time. Veterans Access, Choice, and Accountability Act of 2014 extended services to veterans who had waited more than 30 days for care or lived more than 40 miles from a VA medical center. Under this arrangement, Health Net served as the third-party administrator, procuring private health care for veterans, reimbursing providers for services to veterans, and billing the VA.

When a local VA Medical Center is unable to offer the care, this innovative initiative provides eligible Veterans with coordinated, timely access to care through a comprehensive network of non-VA physicians who satisfy VA quality standards. In three of the six Patient Centered Community Treatment regions, Health Net assisted the VA in providing care to veterans. All or parts of 37 states, Puerto Rico, and the Virgin Islands are covered by these three regions - Regions 1, 2, and 4.

Since their 2013 contract, Health Net Federal Services has managed many contracts for the Department of Veterans Affairs. The VA Outpatient Recovery Audit identified overpayments made by the VA to non-VA providers, helping to maximize care for Veterans through proper payments; and the VA’s Rural Mental Health program, a program aimed at providing primary, preventive, and behavioral health care to Veterans of all ages and military backgrounds across the United States.

However, the VA Office of Inspector General (VA OIG) audited Health Net in 2017 and discovered evidence that the company had billed the VA for duplicate claims totaling approximately $30 million and had failed to reduce billings to the VA for approximately $1 million in provider rate savings, as required by contract. The subsequent inquiry verified the wrongdoing, and Health Net eventually refunded $93,682,428 in overpayments plus $3,554,963 in interest.

Furthermore, eleven (11) senators, led by Jon Tester and Mike Crapo, wrote to Secretary David Shulkin in 2018 to express their dissatisfaction with the way Health Net oversees veterans’ programs, claiming that Health Net is “ultimately responsible for the Veterans Affairs poor performance.”

According to the letter, providers dealing with Health Net in the senators’ states face extreme waits for reimbursement—if they are compensated at all. According to the senators, many of those providers are small and have large VA accounts while waiting for comments from Health Net. In their letter, the senators also stated that the state deserves more than Health Net’s dismal customer service, which looks to be paying even less attention to the Choice Program as its deadline approaches.

Acting United States Attorney Talbert stated that providers must be held to the highest standard of care and must strictly adhere to their contractual obligations, emphasizing that the agency is committed to assisting the VA and other federal agencies in ensuring the integrity of critical federal programs, such as those funded by settlements that will benefit veterans.

“The VA Office of Inspector General is committed to promoting fiscal accountability throughout VA,” said VA Inspector General Michael J. Missal. He further claimed that the agreement will allow money to be returned to VA programs and services that directly benefit the nation’s veterans.

The US Attorney’s Office for the Eastern District of California and the Civil Division’s Commercial Litigation Branch collaborated to obtain this agreement, with help from the Department of Veterans Affairs Office of Inspector General and the Federal Bureau of Investigation. For the United States, the case was handled by Assistant U.S. Attorney Catherine J. Swann.

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A Father with ALS on a Traveling Mission of Advocating Health Care

A Santa Barbara father who was diagnosed with a progressive nervous system disease instead chose to spend his last living days traveling around the country in hopes of advocating proper health care to the public.

Overview

Even though he has difficulties in traveling due to his disease, the Santa Barbara resident and a father of one named Ady Barkan has chosen to spend the remainder of his life traveling around the country to specifically advocate proper health care to the public, according to a news report article posted by NBC 4 Los Angeles.

The Progressive Nervous System Disease Called ALS

At the young age of 34, Barkan’s dreams of providing a good father figure to his only child was struck down after he was diagnosed with ALS or Amyotrophic lateral sclerosis (also known as the motor neurone disease (MND) or Lou Gehrig’s disease in some cases) is a type of progressive nervous system disease that severely affects nerve cells in the brain and in the spinal cord, resulting in the permanent loss of muscle control throughout the whole body.

The disease causes the muscles of the body to stiffen, resulting in muscle wasting (the loss of skeletal muscle mass which is essential for the movement of the limbs). It also includes muscle twitching (involuntary muscle contraction), along with gradual increasing weakness on the affected muscles. It usually starts with the arms and legs, but a variant called bulbar-onset ALS starts instead with the difficulty speaking or swallowing.

Half of all affected individuals will develop at least mild difficulties with thinking and their behaviour, while 15% of those individuals has the risk of developing  Frontotemporal dementia (behavioural or language disorders).

Unfortunately, as time passes by for the affected individual with ALS, it becomes a fatal disease as it will eventually affect one’s breathing and the heart’s ability to pump blood needed for circulation of oxygen inside one’s body. This is what took the life of Stephen William Hawking, one of the well-known English theoretical physicists, cosmologists, and author, who was director of research at the Centre for Theoretical Cosmology at the University of Cambridge at the time of his death.

Ady Barkan, the Hero for Medical Care Advocacy

Before the tragedy happened to Barkan, he was a regular father that was young and at his prime who regularly took runs down the California coast. He was a proud father of his only son, Carl. As he was diagnosed with the life-altering and fatal disease, he wanted to leave a legacy not only for his child, but to others as well that may face a similar situation to his.

He stated in an interview in 2018 that before his life ended, he wanted to do something that would make him proud of it, along with others like his son who would be proud of his father’s advocacy during his lifetime. Barkan wants to be remembered by the public as the figure who advocated for proper medical care for everyone who is in need of such service in their lifetime. He also wants for others to continue such advocacy in order to maintain it once it has been achieved.

The Incident That Started Barkan’s Advocacy

In January 2018, in order to help his wife cut overall costs, he decided to switch over to Health Net for his medical needs, thinking that the company would be of good help to his situation. However, his good image and expectations of Health Net was shattered into pieces when it ruled out that the ventilator and the medicine provided to him was not of a necessity.

That means that Barkan has to pay for the full price of such service, and his health insurance provider of Health Net will not help him in any way possible. That opened his eyes to the ugly truth of some health care companies do to their own patient members, and Barkan created the said advocacy to prevent such things from happening again to others in the near future.

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Centene Amidst a Scandal: Still Focuses on Profits

The CEO of Centene still focuses on the profits his company makes despite accusations being hurled at him and his company.

Overview

Profits are the name of the game when it comes to the current mission of Centene and to the mindset of its CEO, Michael F. Neidorff. He said that their priority would be profits, specifically the massive growth of their net profits, and their executive pay as fast as he sustainably can, according to an article posted in The Marietta Times.

Due to his mindset and the company’s priorities, many in the public are starting to become seriously concerned about it. That is especially true since Centene has been accused of wrongdoings within its premises, in which it was forced to pay those accusations out to settle those.

More on Neidorff

For those who are unfamiliar with Centene’s current CEO, Michael F. Neidoriff is one of the well-known and top-paid healthcare executives, wherein his earnings per year sum up to $25 million. When broken down to a 60-hour work schedule per week (assuming that he does), it would be $8,000 per hour. That amount is what a typical American employee will earn in a year.

Centene’s Growth and Long-Term Goals

Neidorff aims for the company to grow rapidly by stating assuringly that Centene’s profits will be increased in 2024, amounting to about a third overall. That remark has been bluntly spoken by Centene’s CEO against people who are questioning its growth, despite paying an amount of $1 billion to settle a whopping 22 claims of wrongdoings from various states.

Many in both the public and private sector have raised their eyebrows over Neidorff claims, especially when additional claims have been made against his company. Most of those additional claims were dishonest conduct when it comes to the company’s acquisition of various contracts for prison care, wherein it is a business partnership with the U.S. government. However, when it comes to that issue, Neidorff simply avoided it by not mentioning nor apologizing over it and instead focused more heavily on his company’s growth and profit.

The increased net income margin bracket amount aimed by Neidorff and his company Centene by 2024 is at least  3.3%. He stated that they have overstayed their welcome in the 2.6% to 2.7% net income margin bracket. He added that his goal is backed up by his entire board of members and shares the same sentiment when it comes to the company’s growth. It will be given top priority and importance just like long-term management incentive programs.

In short, he wants for him and the executives under him to earn a billion more in terms of profit by 2024.

Eyebrows of Many Are Raised and Questioning

Many watchdogs in both the public and private sectors are getting worried and alarmed on the current mindset and goals of Neidorff and his company over the next few years.

One of those people named Catherine Tercer from Common Cause Ohio finds it very tacky on their end. She has added that being thoughtful and transparent is important, and Centene’s current goals and the statement of its CEO is very unattractive.

Due to that, many states are reconsidering their idea of partnering up with Centene and letting it handle the vast sums of taxpayer money that they are handling on their end. Add to the fact that Centene won’t release a statement about how they handle the sums of taxpayer money assigned to them and Neidorff salary when even asked about it directly.

That baffles many, as the company’s revenue is shared from the tax dollars that were especially meant to help the financially burdened and poorest Americans.

However, when it comes to improper means when it comes to supercharging profits, the company vehemently denies doing such practice. Centene has stated that it strictly follows all relevant regulations, whether it would be a local, a state, and a federal kind. Additionally, it has added that it strictly adheres to the terms of each contract from each individual state that it is currently binded with.

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City Attorney Sues Two Huge Health Insurance Providers Due to Allegations of Underpaying

One brave city attorney stands up against the atrocities done by two health insurance companies in the past. Their actions can severely affect the effectiveness of emergency services due to the underpayment that they have received over the past few years.

Overview

A city attorney based in San Francisco by the name of Dennis Herrera has filed a lawsuit against two health insurance companies, namely Blue Cross (and its affiliates) and Health Net respectively. The reason for such a lawsuit is due to the allegations that both companies have unlawfully schemed to systematically underpay San Francisco and other public health hospitals within the state, wherein both companies are offering their health insurance plans according to a news article report posted by the City Attorney of San Francisco.

The Details Down Below

According to the available public details of the said lawsuit, it was filed in the office of San Francisco Superior court on the 25th of May, 2011. Aside from the allegations of intentional underpayment to both of the mentioned providers, Herrera also added the additional charges of deliberately delaying claim payments and the fact of unjustly enriching themselves at the expense of California’s public hospitals.

Another surprise was added to the lawsuit as after filing the first two companies, Herrara added the third company by the name of Anthem Blue Cross Life and Health Insurance Company that is also part of those mentioned allegations earlier. All three defendants are accused of violating the Unfair Competition Law due to the illegal practices that all companies have implemented against California’s public hospitals.

In the case of Herrera, since he is pursuing this kind of case on the behalf of the People of California, a favorable ruling could be given that will greatly benefit most public hospitals in the said state. Do take note that most of the operating hospitals that have been affected by the schemes of those three mentioned companies have severely suffered from underpayments before this case was filed by Herrera himself.

Herrera Seeks Compensation for Affected Hospitals and Penalties for the Defendants

When Herrera initially filed the lawsuit against the three providers, he sought an injunction for the immediate shutdown of the three medical providers’ unfair and illegal business practices. Additionally, he also wanted for a court order to be immediately implemented against the three, wherein it will require them to pay the full restitution for all underpayments that they have made, together with the total amount of interest.

Civil penalties were also part of Herrera’s lawsuit as it wants for each company to pay penalties for up to $2,500 each for every violation made against the California Business and Professions Code section 17200. Lastly, the lawsuit also wants the full recovery for the City’s cost of pursuing such a case.

Herrera said in a statement that the providers that they have sued are illegally shortchanging public hospitals within the state of California, and as a result, sticking that to the taxpayers without their knowledge. He added that a specific Californian law imposes a duty to the San Francisco General Hospital and other public hospitals within the state to provide emergency treatments to all patients in need, regardless if the said patient has the ability to pay or not. Fortunately enough, that law is being duly fulfilled by the mentioned public hospitals above without fail.

The only unfortunate thing is that both Blue Cross and Health Net have flouted their own obligations under the said law. They are intently not reimbursing public hospitals for all the emergency medical treatment a policyholder receives. That kind of particular business practice has been confirmed to be unfair and illegal, and as a result of that, it jeopardizes the City’s ability to provide the needed emergency health care during the time of a crisis.

Herrera ended his statement saying that he is fully intends for those three defendants to pay every single dollar they owe to the affected institutions and the public itself.

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Centene Amidst a Scandal: Still Focuses on Profits

The CEO of Centene still focuses on the profits his company makes despite accusations being hurled at him and his company.

Overview

Profits are the name of the game when it comes to the current mission of Centene and to the mindset of its CEO, Michael F. Neidorff. He said that their priority would be profits, specifically the massive growth of their net profits, and their executive pay as fast as he sustainably can, according to an article posted in The Marietta Times.

Due to his mindset and the company’s priorities, many in the public are starting to become seriously concerned about it. That is especially true since Centene has been accused of wrongdoings within its premises, in which it was forced to pay those accusations out to settle those.

More on Neidorff

For those who are unfamiliar with Centene’s current CEO, Michael F. Neidoriff is one of the well-known and top-paid healthcare executives, wherein his earnings per year sum up to $25 million. When broken down to a 60-hour work schedule per week (assuming that he does), it would be $8,000 per hour. That amount is what a typical American employee will earn in a year.

Centene’s Growth and Long-Term Goals

Neidorff aims for the company to grow rapidly by stating assuringly that Centene’s profits will be increased in 2024, amounting to about a third overall. That remark has been bluntly spoken by Centene’s CEO against people who are questioning its growth, despite paying an amount of $1 billion to settle a whopping 22 claims of wrongdoings from various states.

Many in both the public and private sector have raised their eyebrows over Neidorff claims, especially when additional claims have been made against his company. Most of those additional claims were dishonest conduct when it comes to the company’s acquisition of various contracts for prison care, wherein it is a business partnership with the U.S. government. However, when it comes to that issue, Neidorff simply avoided it by not mentioning nor apologizing over it and instead focused more heavily on his company’s growth and profit.

The increased net income margin bracket amount aimed by Neidorff and his company Centene by 2024 is at least  3.3%. He stated that they have overstayed their welcome in the 2.6% to 2.7% net income margin bracket. He added that his goal is backed up by his entire board of members and shares the same sentiment when it comes to the company’s growth. It will be given top priority and importance just like long-term management incentive programs.

In short, he wants for him and the executives under him to earn a billion more in terms of profit by 2024.

Eyebrows of Many Are Raised and Questioning

Many watchdogs in both the public and private sectors are getting worried and alarmed on the current mindset and goals of Neidorff and his company over the next few years.

One of those people named Catherine Tercer from Common Cause Ohio finds it very tacky on their end. She has added that being thoughtful and transparent is important, and Centene’s current goals and the statement of its CEO is very unattractive.

Due to that, many states are reconsidering their idea of partnering up with Centene and letting it handle the vast sums of taxpayer money that they are handling on their end. Add to the fact that Centene won’t release a statement about how they handle the sums of taxpayer money assigned to them and Neidorff salary when even asked about it directly.

That baffles many, as the company’s revenue is shared from the tax dollars that were especially meant to help the financially burdened and poorest Americans.

However, when it comes to improper means when it comes to supercharging profits, the company vehemently denies doing such practice. Centene has stated that it strictly follows all relevant regulations, whether it would be a local, a state, and a federal kind. Additionally, it has added that it strictly adheres to the terms of each contract from each individual state that it is currently binded with.

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A Father with ALS on a Traveling Mission of Advocating Health Care

A Santa Barbara father who was diagnosed with a progressive nervous system disease instead chose to spend his last living days traveling around the country in hopes of advocating proper health care to the public.

Overview

Even though he has difficulties in traveling due to his disease, the Santa Barbara resident and a father of one named Ady Barkan has chosen to spend the remainder of his life traveling around the country to specifically advocate proper health care to the public, according to a news report article posted by NBC 4 Los Angeles.

The Progressive Nervous System Disease Called ALS

At the young age of 34, Barkan’s dreams of providing a good father figure to his only child was struck down after he was diagnosed with ALS or Amyotrophic lateral sclerosis (also known as the motor neurone disease (MND) or Lou Gehrig’s disease in some cases) is a type of progressive nervous system disease that severely affects nerve cells in the brain and in the spinal cord, resulting in the permanent loss of muscle control throughout the whole body.

The disease causes the muscles of the body to stiffen, resulting in muscle wasting (the loss of skeletal muscle mass which is essential for the movement of the limbs). It also includes muscle twitching (involuntary muscle contraction), along with gradual increasing weakness on the affected muscles. It usually starts with the arms and legs, but a variant called bulbar-onset ALS starts instead with the difficulty speaking or swallowing.

Half of all affected individuals will develop at least mild difficulties with thinking and their behaviour, while 15% of those individuals has the risk of developing  Frontotemporal dementia (behavioural or language disorders).

Unfortunately, as time passes by for the affected individual with ALS, it becomes a fatal disease as it will eventually affect one’s breathing and the heart’s ability to pump blood needed for circulation of oxygen inside one’s body. This is what took the life of Stephen William Hawking, one of the well-known English theoretical physicists, cosmologists, and author, who was director of research at the Centre for Theoretical Cosmology at the University of Cambridge at the time of his death.

Ady Barkan, the Hero for Medical Care Advocacy

Before the tragedy happened to Barkan, he was a regular father that was young and at his prime who regularly took runs down the California coast. He was a proud father of his only son, Carl. As he was diagnosed with the life-altering and fatal disease, he wanted to leave a legacy not only for his child, but to others as well that may face a similar situation to his.

He stated in an interview in 2018 that before his life ended, he wanted to do something that would make him proud of it, along with others like his son who would be proud of his father’s advocacy during his lifetime. Barkan wants to be remembered by the public as the figure who advocated for proper medical care for everyone who is in need of such service in their lifetime. He also wants for others to continue such advocacy in order to maintain it once it has been achieved.

The Incident That Started Barkan’s Advocacy

In January 2018, in order to help his wife cut overall costs, he decided to switch over to Health Net for his medical needs, thinking that the company would be of good help to his situation. However, his good image and expectations of Health Net was shattered into pieces when it ruled out that the ventilator and the medicine provided to him was not of a necessity.

That means that Barkan has to pay for the full price of such service, and his health insurance provider of Health Net will not help him in any way possible. That opened his eyes to the ugly truth of some health care companies do to their own patient members, and Barkan created the said advocacy to prevent such things from happening again to others in the near future.

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Health Net Federal Services Pays over $97M for Overstated Billings to the VA

Health Net Federal Services has paid $97,237,391 to resolve duplicate and inflated claims submitted to the Department of Veterans Affairs, according to Acting U.S. Attorney Phillip A. Talbert.

Health Net inked a $5.05 billion deal with the Veterans Affairs in 2013 as part of the Patient-Centered Community Care initiative, which provided private health care to veterans when VA facilities couldn’t provide it on time. Veterans Access, Choice, and Accountability Act of 2014 extended services to veterans who had waited more than 30 days for care or lived more than 40 miles from a VA medical center. Under this arrangement, Health Net served as the third-party administrator, procuring private health care for veterans, reimbursing providers for services to veterans, and billing the VA.

When a local VA Medical Center is unable to offer the care, this innovative initiative provides eligible Veterans with coordinated, timely access to care through a comprehensive network of non-VA physicians who satisfy VA quality standards. In three of the six Patient Centered Community Treatment regions, Health Net assisted the VA in providing care to veterans. All or parts of 37 states, Puerto Rico, and the Virgin Islands are covered by these three regions - Regions 1, 2, and 4.

Since their 2013 contract, Health Net Federal Services has managed many contracts for the Department of Veterans Affairs. The VA Outpatient Recovery Audit identified overpayments made by the VA to non-VA providers, helping to maximize care for Veterans through proper payments; and the VA’s Rural Mental Health program, a program aimed at providing primary, preventive, and behavioral health care to Veterans of all ages and military backgrounds across the United States.

However, the VA Office of Inspector General (VA OIG) audited Health Net in 2017 and discovered evidence that the company had billed the VA for duplicate claims totaling approximately $30 million and had failed to reduce billings to the VA for approximately $1 million in provider rate savings, as required by contract. The subsequent inquiry verified the wrongdoing, and Health Net eventually refunded $93,682,428 in overpayments plus $3,554,963 in interest.

Furthermore, eleven (11) senators, led by Jon Tester and Mike Crapo, wrote to Secretary David Shulkin in 2018 to express their dissatisfaction with the way Health Net oversees veterans’ programs, claiming that Health Net is “ultimately responsible for the Veterans Affairs poor performance.”

According to the letter, providers dealing with Health Net in the senators’ states face extreme waits for reimbursement—if they are compensated at all. According to the senators, many of those providers are small and have large VA accounts while waiting for comments from Health Net. In their letter, the senators also stated that the state deserves more than Health Net’s dismal customer service, which looks to be paying even less attention to the Choice Program as its deadline approaches.

Acting United States Attorney Talbert stated that providers must be held to the highest standard of care and must strictly adhere to their contractual obligations, emphasizing that the agency is committed to assisting the VA and other federal agencies in ensuring the integrity of critical federal programs, such as those funded by settlements that will benefit veterans.

“The VA Office of Inspector General is committed to promoting fiscal accountability throughout VA,” said VA Inspector General Michael J. Missal. He further claimed that the agreement will allow money to be returned to VA programs and services that directly benefit the nation’s veterans.

The US Attorney’s Office for the Eastern District of California and the Civil Division’s Commercial Litigation Branch collaborated to obtain this agreement, with help from the Department of Veterans Affairs Office of Inspector General and the Federal Bureau of Investigation. For the United States, the case was handled by Assistant U.S. Attorney Catherine J. Swann.

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Health Net Fails in Acquiring PeaceHealth; Now Being Ordered by Court to Clarify Status

The health care provider PeaceHealth still maintains that it will not be part of Health Net’s network and its affiliate of Trillium Community Health Plan.

Overview

 The United States District Judge Michael McShane has ordered two health care providers, namely Health Net and Trillium Community Health Plan to make clear that a separate health care provider by the name of PeaceHealth will definitely not be a part of former’s in-network system, according to a news report article posted by The Register-Guard.

PeaceHealth is a health care company that operates in Lane County and is one of the biggest providers in the said location. In 2019, it filed a lawsuit against both Trillium Community Health Plan and its current affiliate Health Net Health Plan of Oregon. The main focus of the said lawsuit is due to the false advertising of the plaintiff’s relationship to both defendants, wherein it states that it has terminated its working relationship with them a few months ago before the lawsuit was filed in court.

Additional Details of The Lawsuit

 Judge McShane has issued a temporary restraining order against both Trillium and Health Net and ordered both companies to put immediate notices in their websites that make a clear message about their issue with PeaceHealth. The message should contain that PeaceHealth would clearly not be part of either defendant’s in-network for their Medicare Advantage patients starting the following year of 2020.

Do take note that before the said issue between the three companies is that PeaceHealth had long-standing agreements with both companies (Trillium and Health Net) wherein PeaceHealth will provide in-network hospital and doctor’s care for their Medicare Advantage patients during that time, wherein it started in 2004 with Health Net and in 2012 with Trillium respectively.

Unfortunately, those long-standing agreements broke down after the accusations of PeaceHealth in regards to the fraudulent misinformation that they have terminated both agreements, but instead PeaceHealth insists that it was both Health Net and Trillium who cut ties with them, not the other way around as suggested by the fraudulent misinformation being spread out by the two defendants.

A Possible Misunderstanding (Or Not)?

 Even though PeaceHealth was indeed going to terminate their in-network connection with the two defendants, it was going to happen instead on the first day of the following year, January 1, 2020.

PeaceHealth has made sure that their intention was well-received by both companies and in April 2019, the management of PeaceHealth has provided both of the companies’ management of official documentation of its intention to its long-standing agreements to each company in the following year. The said documentation also stated that massive changes will happen in affected locations, such as the hospitals located in Cottage Grove, Eugene, and Springfield locations, along with its group medical offices that locally serves each are mentioned.

However, as early as the 15th of October 2019, both companies have started to provide false information that PeaceHealth would still be part of either companies’ in-network and will still continue to provide hospital and doctors care to Medicare Advantage patients who are enrolled to either one of them.

Obviously, the management of PeaceHealth was infuriated to hear such fraudulent misinformation being given out to patients, in which they filed a lawsuit against both companies as a result.

In response to the action done by PeaceHealth, both companies have stated that the action of the plaintiff was both “unnecessary and improper”, and by doing so ceased any representation of a 2020 in-network pact with them well before a final meeting that was supposed to be held on the 8th of October, 2019.

The two defendants also accused PeaceHealth of an “abrupt termination of a long-standing relationship” between them that resulted in such a scenario between the three entities, in which the defendants believed that it could have been avoided if not for the actions of PeaceHealth.

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Health Net Facing a Lawsuit After a Massive Data Breach Attack Against Accellion

The usage of a 20-year old software from California Accellion led to almost 1.9 million Health Net members’ data to be compromised after the said breach.

Overview

 A massive cloud solutions information company called Accellion, Inc. wherein their flagship device called File Transfer Appliance (FTA) was recently hacked in December 2020 and many companies and institutions were severely affected by the said cyberattack.

One such company to be heavily affected by it would be Health Net, Centene Corporation’s subsidiary that is now facing a possible lawsuit from patient members whose data were stolen in the said hack, according to a news article report posted by Info Risk Today.

The Effect of the Cyber Attack

 1.9 million patient members have been affected by the cyberattack that resulted from an information breach of Accellion’s servers, of which 9 of their servers were severely breached and hacked in their California data center being run by IBM. Most of the information affected on Health Net’s side is health care information and some personal information.

Once the information in regards to the breach has been finalized, the said incident would be the largest of its kind in the health insurance industry reported under the HITECH Act breach notification rule so far, which was started in September 2009. The previously known data breach that affected the health insurance industry on such a scale was the New York City Health and Hospital Corps data breach that happened to affect 1.7 million users during that said incident.

The cybercriminals were able to get access to all of the data within Accellion’s servers through the usage of their own latest flagship product, the File Transfer Appliance (FTA). This was a huge blow to Accellion, as they primarily specialize in content firewall protection, a specific platform that is designed to protect data from breaches and minimizes compliance violations from third-party entities and sources.

Health Net’s Response to the Cyberattack

 The management and representatives of Health Net kept a tight-lipped approach when it came to providing an answer to the incident that led to its patient members being severely affected by the said cyberattack.

However, it is the California Department of Managed Healthcare (CDMH) that initially released the information about 1.9 million patient members’ accounts of Health Net being severely affected by the hack. Out of 1.9 million, more than 622,000 enrollment information of Health Net member patients has been stolen, while more than 223,000 enrolled members’ accounts in CDMH were stolen during the attack.

Due to what happened, CDMH has started an in-depth investigation on what and how the patient members’ information of Health Net was stolen.

A separate breach attack that happened in early February has kept Connecticut Attorney General Goerge Jepsen worried about the information and safety of nearly 25,000 residents of that state, stating that those pieces of information have been clearly compromised.

Jepsen tried to request additional information on the said data breach, but as of this writing, he was yet to acquire the data he has requested. Jepsen was wondering by that time what steps would companies such as Health Net take in order to protect the valuable information of its members.

Further Action Taken by Other Entities

 A different entity by the name of CaseyGerry has started an investigation against Health Net in regards to the data breach that it has experienced after the cloud solutions information company Accellion was hacked and all of Health Net’s data was stolen from 9 main servers ran by IBM, according to the news article report that it has posted in their website.

It is notable that Health Net was a certified client of Accellion when the said cyberattack happened. The stealing of information happened during a file transfer session, which ended in the compromise of millions of patient accounts that are with Health Net during that time.

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Health Net Denied To Cover Medical Necessary Treatments

When you are a healthcare professional, you can witness different scenarios and multiple complaints about how incompetent those giant health insurance companies are in the United States. Having medical insurance here in California is neither necessary nor required; according to them, it will save you shortly when seeking medical attention. But it’s far from what happened to these two people who suffered because of Health Net Inc. Two Doctors from Los Angeles joined the two patients to file lawsuits for denying claims or denying claims based on the insurer’s definition of “medical necessity.” Health Net Inc. illegally denied patients medical treatments even though physicians had ordered them. There are medical rules and conditions on how to level the situation of patients if it is necessary or not. 

There’s a law here in California where insurers are allowed to cover. Los Angeles County Superior Court claims Health Net violated the law by refusing to pay for two patients’ treatments. Health Net is being unfair to everyone and runs unlawful business practices. The managed care plan operates mainly in the western United States and has 2.3 million members in California. March 2011 Robert Mendoza, a 59 years old man, was diagnosed with an aggressive and rare form of prostate cancer, and his doctor urged immediate treatment.

Mendoza’s doctor. Advised a minimally advised they have robotic-assisted surgery that Health Net was willing to cover. According to Mendoza, he needs to raise $30,000, which is out of his pocket. Health Net denied his request for coverage. With the help of USC’s Norris Cancer Hospital, they undergo Mendoza for a second opinion and his doctor. They have recommended more extraordinary because of the progressive nature of his advanced on. 

For the second time around, Health Net denied the treatment as not being medically necessary. The reason why Mendoza uses his own money and proceeds from his wife’s life insurance policy to pay for surgery to survive. He said Health Net has declined to reimburse him. “It’s had a dramatic financial impact on the whole family,” said Mendoza, and until now, Mendoza is paying more e than a thousand dollars a month in premiums. See how evil Health Net Inc. is. 

Their members need they choose to deny its coverage and focus only on their profit. For ten years, 33 years mother and student KalanaPenner suffered from a nerve condition that caused chronic back, neck, and head pain. Kalana’s neurosurgeon recommended she undergo “occipital nerve stimulation.”

The year 2011 after the medical review of Health Net’s denial and successful shea surgery soon after. According to Penner, not all consumers have a strong personality and resources to pursue an appeal. 

“I lost some of my life to this stalling by the insurance company,” she said. After her successful surgery, Health Net turned down his coverage. 

With the help of two lawyers Shernoff and Rocky Delgadillo, who have a history of suing insurers over alleged abuses? These two attorneys sued Health Net and other insurers for canceling consumers’ insurance policies after the patients became sick and filed expensive medical claims. After I heard those stories, I lost hope for the future, everyone got weak, and we were required to have medical insurance because we badly needed it to help us in the future. 

However, this kind of Health Insurance was abused and took advantage of people; they wanted a considerable profit to fulfill their pockets. Profit over lives and those big CEO still have the guts to build unworthy organizations. I feel sad for those who can’t afford it and have a big chance of suffering shortly because health insurance companies like Health Net will never give them help.

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Former Competitors to Now Allies: Centene Corporation Acquires Health Net for $6.8 Billion

Now turn allies, Centene Corporation and its new subsidiary Health Net will aim to become the dominant health insurance company in the health care industry.

Overview

 Once known rivals in the health care industry, both Centene Corporation and Health Net shocked and surprised their competitors and customers alike as the former bought out the latter through a lucrative $6.8 billion acquisition deal that took place in 2015, according to a news article report posted by The New York Times.

However, the said acquisition was not purely bells and whistles as Centene Corporation also got the debts of Health Net when it was still a separate company on its own. Now that it became a subsidiary of the larger Centene Corporation, the parent company would bear the debts of its newly acquired subsidiary, which others have started to question the worthiness of the said acquisition.

The Acquisition Details and Miscellaneous

 Thanks to the acquisition of its former rival Health Net, Centene Corporation is now one of the biggest health care providers in the United States. The said acquisition created a company with more than 10 million members, along with an estimated revenue of $37 billion each year, starting from the year where the acquisition was fully completed.

Additionally, it would naturally give Centene Corporation an edge over the marketplace against its competitor’s thanks to its now wide reach. It would also expand Centene’s scale over the whole health care industry as a result.

Before the completion of the acquisition, the market share value of Health Net was $78.57 per share, wherein it represented a 21% premium to its closing price before it was fully acquired. However, the said deal wasn’t without its own catch as Centene Corporation got Health Net’s debt of $500 million by default.

Centene Corporation’s chairman, presiden, and CEO Michael F. Neidorff has stated his pleasure of having Health Net aboard their ranks in a state he has given. He added that the agreement that his company and Health Net made would create a positive value for both companies that have been merged together within a system. He ended his statement that holders from both Centene and Health Net will also benefit from the merger, as they will be able to serve them better with enhanced services.

The acquisition deal was subjected to both regulatory and shareholder approval and was completed in early 2016.

Things That Would Happen Next After The Acquisition

 On the side of Health Net, iots former separate shareholders had received $28.25 in cash and 0.622 of a Centene share for each Health Net share they held previously before the merger. That would be the normal for them under the terms of the said acquisition.

Meanwhile, the shareholders of Centene will own about 71 percent of the combined company as a result. While the previous individual shareholders of Health Net would now own the remaining 29 percent after the completion of the merger between the two companies.

Now that Health Net has been absorbed into the system of Centene Corporation, Neidoff would be the de facto chairman, president, and CEO of both companies. The main headquarters for both companies would be based in St. Louis, while on Health Net side, the separate lower management will be still able to keep their previous office location in California.

The president and chief executive of Health Net, Jay M. Gellert, has assisted in the said merger to make the process more smoother and quicker. The whole merging process would be completed via existing cash and debt, according to the management of Centene.

Do take note that Health Net was still serving more than 6 million patient members by providing managed health care services through their products and insurance plans. They are able to do those via both company health plans and government programs like Medicare and Medicaid.

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Facts between Cohen and Health Net

From 2000 to 2001, Long Beach IPA, a subsidiary of Allied, gave medicalcare to Health Net members to pursue the provider services settlement between Health Net and Allied. Health Net joined prover services agreement with Allied Physicians of California to serve as an IPA. Allied decides that in no event, involving, not limited to, pursuant by health net․ shall allied bill, charge, collect a deposit from, seek payment, income, or reimbursement from, or have any recourse against members other than for applicable copayments and non-covered services.

Health Net itself does not provide medical care and Health Nethas misconducts and lawsuits. This insurance company urged different settle to close the controversies. Health Net Lawsuits’ is a federally qualified HMO that provides health care service plans. However, there are complaints from its members that Health Net denied severe treatments, one of the reasons why members’ conditions are critical.

The contract states that no circumstance of any member is liablefor any sums owed by Health Net. Health care providers render services under this agreement, including bills, charges, collect a deposit or other sum or seek compensation and remuneration. Other recourse against the member or other persons acting from a member’s behalf may only bill HEALTH NET Members directly for applicable deductibles or co-insurance amounts and any non-covered services.“

Robert J. Cohen filed a lawsuit against Health Net of California, Inc. and Los Alamitos Medical Center, Inc.

Through his employee benefit plan, Cohen, a member of Health Net’s HMO, had paid the applicable copayments and premiums, so he was notresponsible for paying the bills. After Cohen filed this lawsuit, CA Em-1submitted the accounts to Health Net, which produced them. Cohen got a series of billing statements totaling $744 and dunning notices from CA Em-1 or its collection agent.

Cohen made the applicable copayments, paid nothing else, and nolonger is a Health Net member.

Cohen sued CA Em-1 and its collection service; however, they arenot included in this appeal. 

The trial court granted Health Net’s and Los Alamitos’s motionsfor summary judgment. Concluded Cohen’s claims we staggered by the Employee Retirement Income Security Act of 1974 was subject to California Department of Managed Health Care’s exclusive regulatory powers or had no merit under the undisputed facts.

Cohen affirmed various causes of litigation and theories against

Health Net and Los Alamitos, specifically fraud, unfair business practicesunder the California unjust competition law (UCL), intentional infliction ofemotional discomfort, bad insurance faith, and delinquency.

Under Proposition 64, Cohen lacks standing to prosecute his

California unfair competition lawsuit because he suffered no actual loss ofmoney or property due to the impaired conduct.

Legal Aid Society of Orange County paid for health insurancebenefits for its ERISA plan through a commodity known as PacAdvantage, which demands benefits through Health Net and other HMOs and medical service providers.

August 2002 when the time for lawsuits filed by Cohen against

Health Net. Cohen contacted CA En-1’s collection Services about the bills he had been receiving foul on Aug 29, and Cohen received his net bill for $226. The accounts have fully paid, and collection efforts have ceased.

In the Disposition, the order awarding discovery sanctions for

$2,050 against Cohen and his counsel. In all other respects, the judgment is affirmed to respondents to recover costs incurred in this appeal.

Cohen submitted a letter to Health Net from the DMHC levyingfines against Health Net for failure to pay claims from emergency careproviders within the statutory time frame.