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Louisiana sues health care company over practices under investigation in Ohio – Ohio Capital Journal

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Louisiana sues health care company over practices under investigation in Ohio – Ohio Capital Journal


Louisiana is suing well being care large UnitedHealth over a number of enterprise practices, saying it’s in search of “to get well billions of {dollars} in inflated prescription-drug costs” for the state Medicaid program.

Amongst its allegations, the state accuses the corporate of gaming federal oversight experiences meant to make sure that a minimum of 85% of the cash it will get from taxpayers goes to pay for well being care. In Ohio, the place United has lengthy been a managed-care supplier, the Medicaid division has saved these experiences secret at United and different managed-care suppliers’ request.

Louisiana Legal professional Normal Jeff Landry final week sued UnitedHealth, saying he was bringing the “go well with to get well billions of {dollars} in inflated prescription drug costs charged by the defendants to the Louisiana Medicaid program.”

Minnesota-based UnitedHealth Group is the fifth-largest company in the US by income. It’s the most important well being insurer by way of market share and, by means of strikes resembling shopping for docs’ places of work, it’s changing into an ever greater participant in myriad different features of well being care.

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It’s additionally an enormous participant in Medicaid, the state/federal program for the poor and disabled. Its United Healthcare Group Plans administer Medicaid companies in a lot of states, together with Louisiana and Ohio.

United additionally owns the nation’s second-largest pharmacy intermediary, OptumRx, which contracts with United well being plans and managed-care organizations to deal with prescription-drug advantages.

Ohio Legal professional Normal Dave Yost in 2019 sued Optum, claiming it overcharged the Bureau of Staff’ Compensation by $16 million, partially by violating the phrases of its contract with the state. Additionally in Ohio, Optum in 2017 labored by means of opaque transactions to cost the state Medicaid program $26 million extra for pharmaceuticals than it paid the pharmacies that disbursed them.

The Louisiana go well with claims United and its company sibling, Optum, used an identical lack of transparency to cover income and violate its United’s contract with Louisiana. 

The legal professional common mentioned United has been so unforthcoming that it hasn’t even been capable of acquire a replica of the ultimate, signed contract between the associated corporations. 5 months after the AG began requesting data, it received a response in February and “of the two,191 pages contained in these 10 paperwork, 1,816, or 83%, are absolutely redacted,” the lawsuit towards United says.

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It alleges that United and Optum have violated state regulation and their contract to improperly inflate drug prices and conceal rebates and costs they’re gathering from drug producers and pharmacists.

For its half, Optum denies violating the regulation.

“We’re honored to offer pharmacy profit companies to the Louisiana Division of Well being’s Medicaid program that ship entry to extra reasonably priced prescription drugs for shoppers and Louisiana taxpayers,” the corporate mentioned in an emailed assertion. “Our companies are carried out in accordance with state rules and the division’s necessities outlined in our contract, and we consider this lawsuit is with out advantage and can defend ourselves towards these unsupported allegations.”

Among the many unhealthy acts the Louisiana AG is accusing United of: gaming medical-loss ratio — a federally required accounting of how a lot tax cash a Medicaid managed-care supplier is spending on well being care and the way a lot it’s pocketing within the type of income and administrative bills. Sometimes, states require that a minimum of 85% of the cash they offer corporations resembling United be used for well being care. In 2019, United’s Louisiana medical loss ratio — or MLR — was 93%, that means that 93 cents of each greenback it received from the state went to offer well being take care of its shoppers.

However the state’s legal professional common mentioned United has been utilizing its relationship with Optum to inflate bills and faux it’s spending cash on well being care that’s actually ending up as revenue for the company that owns them each.

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“Since solely United is required to abide by the MLR requirement, inflating the drug prices paid to Optum truly helps United meet its MLR however doesn’t create an precise loss to their dad or mum firm,” the Louisiana lawsuit says. “Beneath this scheme, inflated funds to Optum are extra revenue for United, however one counted as prices for functions of assembly the MLR.”

A technique pharmacy middlemen resembling Optum may be inflating prices is by taking cash from managed-care organizations and paying pharmacies for medicine, however then forcing pharmacies to pay again a portion of the cash — after which not reporting it to the managed-care organizations or departments of Medicaid. In different phrases, they may very well be secretly utilizing such a mechanism to unduly revenue off of taxpayer funds meant to assist poor and disabled folks.

Yost, the Ohio legal professional common, this yr has been in search of monetary data from the state’s 5 managed-care organizations in an try and see if that’s taking place. Whether it is, it may very well be a violation of a 2019 state regulation prohibiting pharmacy middlemen from most types of clawbacks.

Yost’s workplace didn’t instantly reply to a request for remark Wednesday.

Maureen Corcoran, Ohio’s Medicaid director, in February instructed The Columbus Dispatch that to date in her division’s investigation, it had been unable to untangle the problem of intermediary clawbacks. Corcoran additionally appeared able to neglect the matter until it discovered one thing horrible.

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Corcoran’s workplace received’t even share the MLR experiences that United and the opposite care organizations filed with the state. Louisiana and several other different states publish them on their web sites, however Ohio’s Medicaid division refuses to, saying that United and the opposite contractors declare they comprise commerce secrets and techniques. 

There may be different data relating to United that Corcoran and her division received’t present.

Final yr, the Medicaid division picked United to be certainly one of six companies to share $22 billion price of managed-care enterprise. 

Mercer, the guide paid $10 million to facilitate the method, apparently instructed evaluators to not take into account that United’s Optum was being sued by the state on claims of fraud. And the Medicaid division has refused to reveal whether or not United can be a Mercer shopper. If true, that’s probably a battle of curiosity.

Additionally, state ethics disclosures present that Corcoran has owned a minimum of $1,000 price of United inventory from when she grew to become Medicaid director and a minimum of by means of 2020. However she didn’t file an affidavit disclosing precisely how a lot inventory she held within the firm as she negotiated and signed an enormous contract with it final yr.

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A spokeswoman for the Ohio Medicaid division didn’t instantly reply to a request for remark.

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Louisiana

Saucier man identified as motorcyclist killed in crash in Louisiana

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Saucier man identified as motorcyclist killed in crash in Louisiana


LAFOURCHE PARISH, La. (WLOX) – Saucier native Dustin Craven, 30, has been identified as the victim of a fatal single-vehicle crash in Louisiana, officials announced on Sunday.

The crash took place during the early morning hours of Sunday on Louisiana Highway 20 near Farmer Lane in Lafourche Parish. Craven, the driver of a 2022 Harley-Davidson Street Glide, was traveling south when the motorcycle left the roadway and struck a utility pole, causing him to be ejected.

As a result, Craven received fatal injuries and died at the scene.

The cause of the crash remains under investigation.

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Live Updates: No. 14 Alabama Softball vs. Southeastern Louisiana (Tuscaloosa Regional Final)

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Live Updates: No. 14 Alabama Softball vs. Southeastern Louisiana (Tuscaloosa Regional Final)


TUSCALOOSA, Ala. — In a high-stakes NCAA Regional final qualifier on Saturday morning at Rhoads Stadium, Alabama Softball and Southeastern Louisiana went into extra innings. Riley Valentine, coming in as a pinch hitter, ignited a five-run rally in the ninth inning with a home run, propelling the Crimson Tide to a 6-3 victory.

After climbing their way back in the loser’s bracket, the Lions and Crimson Tide are set to face off once more on Sunday with a trip to the super regionals on the line. First pitch is scheduled for 1:00 p.m. CT on ESPN2.

BE SURE TO REFRESH YOUR BROWSER FOR THE LATEST UPDATES

(most recent at the top)

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Current Score – T3: Alabama 9, SLU 2.

Top Third – SLU Batting:

Bottom Second – Alabama Batting:

Top Second- SLU Batting:

Bottom First – Alabama Batting:

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Top First – SLU Batting:

Pregame:

Alabama

SLU

Kristen White

Ka’Lyn Watson

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Larrissa Preuitt

Chloe Magee

Kenleigh Cahalan

Maria Detillier

Jenna Johnson

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Bailey Krolczyk

Marlie Giles

Lexi Johnson

Bailey Dowling

Maddie Watson

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Kali Heivilin

Audrey Greely

Riley Valentine

Colleen Kulivan

Emma Broadfoot

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Cam Goodman

P: Jocelyn Briski

P: Ellie DuBois

Who: No. 14 Alabama (33-17), Clemson (34-17), Southeastern Louisiana (45-13) and USC Upstate (30-21)

Where: Rhoads Stadium, Tuscaloosa, Ala.

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When:
Friday, May 17
*Southeastern Louisiana 6, Clemson 2 | 2 p.m. | ACC Network
*No. 14 Alabama1, USC Upstate 0 | 4:30 p.m. | ESPN+
Saturday, May 18
*Game 3: No. 14 Alabama 6, SLU 2 (9 Innings) | 10:30 a.m., ESPN+
*Game 4: Clemson 8, USC Upstate 0 (5 Innings) | 1 p.m. ESPN+
*Game 5: SLU 6, Clemson 2 | 4:30 p.m.
Sunday, May 19
*Game 6 | No. 14 Alabama vs. SLU | 1 p.m. | ESPN2
*Game 7 ​​​​​​​if necessary | TBD



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Endangered whale spotted in western Gulf faces industrial dangers • Louisiana Illuminator

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Endangered whale spotted in western Gulf faces industrial dangers • Louisiana Illuminator


Evidence is mounting that an exceedingly rare whale, unique to the Gulf of Mexico, ranges farther west than previously thought, prompting new worries about the dangers it faces from heavy ship traffic and other industrial activities near Louisiana and Texas.

Scientists spotted two of the approximately 75 remaining Rice’s whales during an aerial survey of marine animals in the western Gulf last month. National Oceanic and Atmospheric Administration researcher Laura Dias saw one of the bus-size whales breaching the surface about 55 miles from Corpus Christi, Texas on April 11.

“I felt a wave of excitement and relief,” she said, describing the culmination of an “intense effort” to photograph the endangered whale species west of Louisiana. Found to be a distinct species just three years ago, the shy, deep-diving Rice’s whale remains largely a mystery. Scientists are racing to learn the basics, including how the whale eats, breeds and communicates, before the species goes extinct.

Recent audio recordings have also offered proof of the whale’s frequent travels in the western Gulf. A NOAA-led analysis of underwater sounds detected the whale’s distinctive “long moan” several times off the coasts of Louisiana and Texas, and offered the first evidence of the whale in Mexico’s waters.

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“This is new knowledge and is critical for our understanding [of the whales] given how heavily industrialized that portion of the Gulf is,” said Melissa Soldevilla, a NOAA scientist who led the acoustical research.

The photos and recordings have upended the theory that the Rice’s whale rarely strayed from DeSoto Canyon in the eastern Gulf near Alabama and Florida.

Ships, oil and plastic 

The new evidence was troubling for Michael Jasny, a marine mammal protection expert with the Natural Resources Defence Council.

“The vast majority of the risk this species faces is from vessel strikes,” he said. “There’s so much more vessel traffic in the central and western Gulf than there is in the east.”

Texas and Louisiana have several busy shipping hubs, including Houston, the U.S.’s fifth-largest container port, and Port Fourchon, which serves nearly all of the Gulf’s 3,200 active oil and gas structures.

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Rice’s whales are “severely vulnerable” to ship strikes because they rest just below the surface at night, Jasny said. This behavior contrasts with most whales, which tend to be nocturnal. A dozing whale is less likely to notice an oncoming vessel, and the vessel’s crew is less likely to spot the whale in the dark.

In 2021, environmental groups petitioned NOAA to set a 10-knot speed limit around DeSoto Canyon. The proposal drew about 75,500 comments and strong opposition from the shipping and oil industries. In October, NOAA denied the petition in favor of an effort to get vessels to slow down voluntarily.

Jasny noted that NOAA adopted a similar 10-knot speed limit along the East Coast to protect the North Atlantic right whale, a species that’s also endangered but has a population that’s likely three times larger than the number of Rice’s whales.

Gulf Coast political leaders have expressed opposition to other measures to protect the whale, including a NOAA proposal to designate 28,000 acres in the Gulf as a new critical habitat.

On May 1, U.S. senators John Kennedy and Bill Cassidy of Louisiana and Cindy Hyde-Smith and Roger Wicker of Mississippi wrote a letter to NOAA warning against “unnecessary measures for the Rice’s whale at the expense of communities along the Gulf of Mexico.” The Republican senators believe whale-related restrictions on shipping and oil and gas development “would directly harm the economic activity and jobs.”

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Rice’s whales are also threatened by oil spills, ocean trash, entanglement in fishing gear and noise, especially blasts from seismic airgun surveys that companies use to find offshore oil deposits.

BP’s Deepwater Horizon oil disaster in 2010 killed nearly 20% of the Rice’s whale population and likely caused widespread health problems and pregnancy failures, according to a NOAA-led assessment.

The growing problem of plastic pollution has also proved fatal for at least one of the whales. In 2019, a 38-foot-long male that washed up on a Florida beach was found to have been killed by a jagged piece of plastic that became lodged in its stomach.

A dead Rice’s whale washed up on a Florida beach in 2019. It was found to have been killed by a plastic fragment lodged in its stomach. (National Park Service)

Discovering a new species

The whale’s death had a silver lining, though. The carcass was a treasure trove of information for scientists and helped prove that the Rice’s whale is a distinct species.

Scientists had long thought Rice’s whales were a Gulf-dwelling variety of Bryde’s whales, another endangered species that ranges widely in the Atlantic and Pacific oceans. Rice’s and Bryde’s whales look almost identical. They grow to around 55 feet, weigh about 30 tons, use baleen to filter-feed and are part of what NOAA calls the “great whales,” a group that includes humpback, sperm and blue whales. But the dead specimen offered a rare opportunity to get a close look at the Rice’s whale’s organs, skeleton and DNA, all of which revealed clear differences.

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A growing body of research indicates the whales’ behavior also sets them apart. While Bryde’s whales feed near the surface on a range of seafood, including krill, shrimp, herring and other small fish, Rice’s whales like to dive deep for one particular menu item: the silver-rag driftfish. And, unlike the free-ranging Bryde’s whales, Rice’s whales are homebodies, preferring to stick to the Gulf’s warm waters.

Some scientists wanted to name the newly-discovered species the “Gulf of Mexico whale” or the “American whale,” because it lives almost entirely in U.S. waters.

In the end, the NOAA scientists who confirmed the whale was a distinct species decided to name it in honor of Dale Rice, a biologist who first recognized some 60 years ago that the Bryde’s whales in the Gulf seemed different from other Bryde’s whales.

Regardless of what they’re called, Jasny hopes more Americans – especially Gulf Coast residents – come to appreciate this massive and mysterious animal, and understand how close it is to vanishing forever.

“This is a really remarkable species,” he said. “They’re unique to the Gulf and even the U.S. We want to make sure people realize how unique they are and how dependent they are on the habitat of the Gulf.”

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This article first appeared on Verite News and is republished here under a Creative Commons license.



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