Inactive Case

United States ex rel. Nezda v. American Imaging Management Inc. et al.

Docket No.
1:15-cv-06937
District Court
Illinois Northern — Eastern

Goal

  • Award damages

Issues

Why This Matters:

A former employee filed a whistleblower lawsuit against a company that contracts with Medicare Advantage insurers to provide prior authorization and utilization management services. The former employee alleges that the defendants violated the False Claims Act by agreeing to wrongfully deny medically necessary care to Medicare beneficiaries at specific rates to meet insurers’ savings goals. The insurers that contracted with this company thus falsely and fraudulently received billions of dollars in improper premium payments from the Medicare program. In 2022, the parties entered into a settlement where the defendants agreed to pay $13 million to resolve these allegations.

Potential Impact:

Ensuring access to care and accurate payment for Medicare Advantage organizations prevents fraud, protects taxpayer dollars, and keeps health care costs low for patients. The False Claims Act is the government’s primary tool to combat health care fraud, and whistleblower lawsuits play an especially important role in protecting patients and consumers by curbing unnecessary and harmful medical treatments, reducing wasteful spending, and deterring fraud to the tune of nearly 10 times the amount that is recovered.

48 Major Filings

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Related Litigation

Current Status

Case Dismissed

Legal Issues

False Claims Act - Submission of False or Fraudulent Claims, False Claims Act - False Certifications or Statements

Date Filed
August 7, 2015
Case Type
Civil
Court Type
District Court
Court
Illinois Northern
Division
Eastern
Judge
Alonso, Jorge L. Appointed By: Barack Obama
Plaintiff(s)
Susan Nedza
Lead Counsel For Plaintiff(s)
Hughes Socol Piers Resnick & Dym Ltd
Defendant(s)
American Imaging Management Inc.; Anthem Inc.; Anthem Health Plans of Kentucky, Inc.; Anthem Health Plans of New Hampshire, Inc.; Anthem Health Plans, Inc. (serving Connecticut); Anthem Insurance Companies, Inc. (serving Indiana); Blue Cross of California; Blue Cross and Blue Shield of Georgia, Inc.,; Blue Cross and Blue Shield Healthcare Plan of Georgia; Community Insurance Co. (serving Ohio); Compcare Health Service Insurance Corp. (serving Wisconsin); Empire Healthchoice HMO; Inc.; Empire Healthchoice Assurance, Inc.; HMO Colorado, Inc.; HMO Missouri, Inc.; Blue Cross of Idaho Care Plus, Inc.; Blue Cross Blue Shield of Michigan Mutual Insurance Company; Blue Cross and Blue Shield of North Carolina; ealth First Health Plans, Inc.; Moda Health Plan, Inc.; Priority Health; Providence Health Plan; Providence Health Assurance; Regence Bluecross Blueshield of Oregon; Regence Bluecross Blueshield of Utah; Regence Blueshield; Regence Blue Shield of Idaho; Asuris Northwest Health; and Pacificsource Community Health Plans
Lead Counsel for Defendant(s)
Foley & Lardner