Category: News Feeds

Ohio has had it with Centene’s alleged “corporate greed.”

The state filed a lawsuit last week claiming that the St. Louis-based Centene company engaged in an elaborate plot to maximize profits at the expense of its Medicaid department. But Centene denies any wrongdoing, stating that the claims are “unfounded.”

The lawsuit alleges that Centene subsidiary Buckeye Health Plan, a managed care organization, used three subcontractors to provide pharmacy benefits in order to inflate costs. This resulted in millions of dollars in overpayments made by the Ohio Department of Medicaid, the state’s Attorney General Dave Yost said in a statement issued last Thursday. 

“Corporate greed has led Centene and its wholly-owned subsidiaries to fleece taxpayers out of millions,” Yost said. “This conspiracy to obtain Medicaid payments through deceptive means stops now.”

The lawsuit comes several years after a Columbus Dispatch investigation that described how Centene’s Buckeye Health Plan contracted with two companies, Envolve Health Solutions and Health Net Pharmacy Solutions, to administer pharmacy benefits though it had already hired CVS Caremark to manage these same benefits. In other words, Buckeye was double-billing the state by using two different sets of pharmacy benefit managers. 

Pharmacy benefit managers administer prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers and other payers. They essentially act as middlemen and their role in the drug distribution chain has faced increased scrutiny in recent years, according to a 2019 explainer by The Commonwealth Fund. This is largely because pharmacy benefit managers often receive rebates that are calculated as a percentage of the manufacturer’s list price, meaning they get a higher rebate for more expensive drugs.

In this case, suspicions were raised due to the fact that Buckeye charged nearly double for prescription drugs compared with other managed care organizations hired by the state to coordinate Medicaid services.

The attorney general’s office, through outside counsel, investigated Centene and Buckeye and found evidence of several contract violations. These include filing reimbursement requests for amounts already paid by third parties, failing to accurately disclose the true cost of pharmacy services and artificially inflating dispensing fees.

The lawsuit was filed in the Franklin County Court of Common Plea under seal due to a confidentiality and nondisclosure agreement.

In a statement issued last week, Centene said that its pharmacy contracts are reviewed and pre-approved by state agencies before they go into effect. The insurer also claimed that these pharmacy benefit services saved millions of taxpayer dollars for Ohioans.

“We look forward to answering any of the attorney general’s questions,” the insurer said. “Our company is committed to the highest levels of quality and transparency.”

This is not the first time AG Yost has gone after pharmacy benefit managers. Just last year, Yost filed a lawsuit against Express Scripts, accusing the company of multiple contract breaches that allowed it to pocket millions in overcharges to the state.

Photo: Hailshadow, Getty Images

Immigration lawyers are sleeping a little better these days, yes, but I can’t say that our days of anxiety are over quite yet. We are constantly scratching our heads about where our clients fit into new policies. One of the latest conundrums revolves around whether a client is impacted by one of the myriad of bans currently on the books.

President Joe Biden kept his promise and reversed the Trump administration’s infamous Muslim Ban immediately upon taking office, making it possible for immigrants from seven Muslim countries to resume their immigration journeys after four years of being shut out of the United States. But that was only one of several bans that emerged in the past few years, particularly during 2020. People have been banned from obtaining new temporary or permanent visas (green cards). The bans are visa- as well as country-specific. Essentially, COVID-19 gave Trump what Congress wouldn’t — limited immigration.

The pandemic brought all U.S. embassies around the world to a complete halt, postponing interviews and appointments that had taken years to schedule — sometimes one year, sometimes 10 or more.

But rather than creating a national strategy for reducing all travel into the U.S. to curb the pandemic, Trump used the opportunity to ban specific visa categories. Biden recently lifted the ban on those getting new green cards but certain work visas such as H-1B (skilled professionals), H-2B (temporary nonagricultural jobs), L-1 (multinational transfers), and J-1 (short-term visas generally used by trainees and au pairs) remain banned. The ban is in place until March 31, 2021.

At the time, industry leaders objected to the ban on work visas, which left many of the workers they had already hired stranded overseas. Their concerns were borne out in 2021 reports that show that the bans were ineffective in saving jobs and that industries, have in fact been harmed and many jobs went unfulfilled.

The country-specific ban includes 26 European countries collectively referred to as the Schengen area. Bans are in place for China, Iran, Brazil, and South Africa.

There are clear exceptions to these bans, such as for U.S. citizens, green card holders, and spouses and minor children of U.S. citizens and green card holders.

For those who do not meet the above exceptions, a national interest exception (NIE) was created for those subject to the Schengen ban. Initially, the exception was to prove their work serves the “U.S. economic interest.” It applied to certain technical experts and specialists, senior-level managers and executives, treaty traders and investors, professional athletes, and their dependents. It should be noted that treaty investors and traders are citizens from countries with which the U.S. has treaty agreements. Treaty investors (E-2 visa) will on average invest at least $100,000 in their U.S. businesses — often much more — and provide the embassy with business plans for creating American jobs. Treaty traders must prove substantial trade between America and the home country. Such noncitizens make contributions to the U.S. economy even before they arrive here.

On March 2, 2021, the current administration rescinded the above guidance for Schengen countries. The exception of “substantial economic benefit” which was broad and allowed noncitizens to show their economic contributions was beneficial to America, is further restricted and replaced by a narrow and specific standard of “vital support for critical infrastructure.”  This standard requires noncitizens to prove their work will benefit specific infrastructure sectors including healthcare and public sector, agriculture, chemical, transport, energy and more listed in a memo by the DHS Cybersecurity and Infrastructure Security Agency.

Many of the visa applicants, especially treaty visa applicants, who have businesses, financial ties, and contributions in the U.S., will unlikely meet these new requirements. Some embassies have emailed immigration lawyers to expect fewer E-visa approvals, others have updated their website to reflect the change.

We as immigration lawyers have found ourselves doing the visa-ban vs. country-ban game. What visa category are we working with, what country is the client from, and is there a national interest exception? And, if there is a NIE, how is a specific embassy handling the process and what kind of evidence do we need? It’s all rather stressful and complicated, especially as not all embassies have been treating the NIE in the same way.

As things stand, the situation is fluid, frustrating, and difficult. Many people who are awaiting entry into the U.S. can actually help our flagging economy. And though there needs to be a balance between the pandemic and the economy, measures can be put into place to ensure those who enter go through a more stringent COVID-testing procedure rather than restricting the visa exceptions.

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Tahmina Watson is the founding attorney of Watson Immigration Law in Seattle, where she practices US immigration law focusing on business immigration. She has been blogging about immigration law since 2008 and has written numerous articles in many publications. She is the author of Legal Heroes in the Trump Era: Be Inspired. Expand Your Impact. Change the World and The Startup Visa: Key to Job Growth and Economic Prosperity in America.  She is also the founder of The Washington Immigrant Defense Network (WIDEN), which funds and facilitates legal representation in the immigration courtroom, and co-founder of Airport Lawyers, which provided critical services during the early travel bans. Tahmina is regularly quoted in the media and is the host of the podcast Tahmina Talks Immigration. She was recently honored by the Puget Sound Business Journal as one of the 2020 Women of Influence. You can reach her by email at tahmina@watsonimmigrationlaw.com or follow her on Twitter at @tahminawatson.

* A Texas brewery has changed its name after another brewery filed a lawsuit claiming the name was too similar to their own. They should have resolved this dispute with a Beerfest-style competition… [San Antonio Current]

* A New York lawyer claims he cannot competently defend his client in court while wearing a mask. [Syracuse.com]

* A Virginia lawyer, who allegedly tried to cultivate a romantic relationship with two clients, has been suspended from practice. [Virginia Lawyer’s Weekly]

* Breonna Taylor’s boyfriend has filed a federal civil rights lawsuit against the Louisville Police Department. [Essence]

* Check out this article on how the lawyer in the Jurassic Park movie differs from the book. Wonder if he still dies in the same memorable way… [Screen Rant]

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Jordan Rothman is a partner of The Rothman Law Firm, a full-service New York and New Jersey law firm. He is also the founder of Student Debt Diaries, a website discussing how he paid off his student loans. You can reach Jordan through email at jordan@rothmanlawyer.com.

As an unprecedented year comes full circle, many businesses are taking the opportunity to reassess their business development strategies, tactics, and goals. For law firms, some trends have become clear – and now is the time to take stock and make sure your firm is keeping up, says business development and marketing expert Deborah Farone.

Assess your technology. “There’s much more stress on the technology that marketing departments are using,” Farone observes. “Because everyone is working from home, people need information online, at their fingertips.” CMOs and partners expect their teams to be able to implement dashboards they can use to access client data, from pitching, to billing, to client service teams.

The tech marketers and lawyers use to connect day-to-day has also found a place in the spotlight. “We’re all pushing the envelope by trying to be more creative in how we engage people,” says Farone. By now, most lawyers know to avoid using cat filters on their Zoom calls – but there’s still plenty to learn. Marketers can lead the way in making seminars and meetings engaging and interactive, using branded backgrounds, chat boxes, polling, and Q&A tools.

Invest in training. This past year has seen a rise in training for lawyers at all stages of their careers. Farone observes: “Firms are realizing that each individual has a value, especially if the firm has downsized or furloughed professionals. Savvy firms are looking at ways to support employees to be the best at what they do. Training helps expand skillsets, but it also sends a message to people that they matter, and that the firm cares about you and wants to invest in your future.” She adds, “Younger lawyers really want to be part of the business and they want a sense of purpose. So I see firms doing more business development training earlier in lawyers’ careers.”

Always connect. By now, if lawyers haven’t gotten into the habit of engaging personally with key clients and contacts, they are putting key relationships at risk. “One-on-one conversations are vital,” says Farone. “If we’ve seen any attribute matter more than ever, it’s empathy.”

At the outset of the shutdown, she advised firms to “Make sure you have a good system to reach out to clients on a regular basis, particularly if you’re not working with them on something. There’s a great value to simply being in touch. Lawyers still can call and ask, ‘How are you doing, is there anything I can do for you?’” They can even offer friendly assistance, such as advice from their IT department or help finding a job for a family member. “Build connections by helping people where it’s appropriate and needed.”

This is another area where marketing teams can be useful, she suggests: “A good marketing department can help develop questions for partners to ask clients, or suggest a few things to offer them – such as joining an online cultural event, or participating in a speaking engagement or webinar.” Personalizing these recommendations is important, of course: “We need to be real and authentic.”

Firms have gotten creative about virtual events, from yoga to gallery tours, to intensive discussions of diversity topics. Still, Farone advises, “You can do all the creative events in the world, but there’s nothing that’s going to replace that personal phone call. I’ve spoken to many general counsel who haven’t gotten these calls, who say how nice it would be if they did. So I think there is a disconnect between the firms saying that they are reaching out, and the clients who are not getting that message.”

Beware of memo fatigue. Building on the “empathy” point, Farone notes, “You really have to understand what your client is going through and provide them with what they need.” Don’t feel obligated to produce client alerts covering every regulatory development – chances are, other firms are doing this already, and clients are overwhelmed with redundant analysis.

“It’s important to ask clients, what kinds of updates do you want? Is it lengthy, in-depth client memos, or would it be better for me to call you, have a weekly meeting with your staff, or host a monthly meeting with others in your industry? Have those conversations and design your outreach based on what your client wants, rather than what we as law firms think they want.”

Look to other industries. Law firms can operate in a bubble, while corporations and other organizations zoom ahead with innovative ways to reach clients. Learn from them, Farone says – for example, focus groups are a great way to gather feedback and spark ideas. Knowledge and a little bit of creativity can spark new marketing ideas.

Get additional insights from Farone and leading law firm partners in Practising Law Institute’s on-demand One-Hour Briefing, Business Development: Best Practices Post-Pandemic.

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Practising Law Institute is a nonprofit learning organization dedicated to keeping attorneys and other professionals at the forefront of knowledge and expertise. PLI is chartered by the Regents of the University of the State of New York and was founded in 1933 by Harold P. Seligson. The organization provides the highest quality, accredited, continuing legal and professional education programs in a variety of formats which are delivered by more than 4,000 volunteer faculty including prominent lawyers, judges, investment bankers, accountants, corporate counsel, and U.S. and international government regulators. PLI publishes a comprehensive library of Treatises, Course Handbooks, Answer Books and Journals also available through the PLI PLUS online platform. The essence of PLI’s mission is its commitment to the pro bono community. View PLI’s upcoming live webcasts here.

Ed. Note: Welcome to our daily feature Trivia Question of the Day!

Which Biglaw firm took the top spot on Vault’s 2021 Best Law Firms in Southern California ranking?

Hint: The firm was founded by its namesake partners in 1934 to focus on tax and employment law.

See the answer on the next page.

Last week, the big story in legal academia — and beyond — was the Zoom conversation recorded between two law professors at Georgetown University Law Center. Adjunct professors Sandra Sellers and David Batson were discussing grading in the negotiations class they co-teach. Sellers was caught on camera saying of a Black student “a lot of my lower ones [students] are Blacks. Happens almost every semester. And it’s like, oh come on, you know? There are some really good ones, but there are also some that are just plain at the bottom and drives me crazy.” While Batson just seems to nod in agreement.

A clip of the Zoom conversation quickly went viral.

What also happened quickly was the law school’s response. Shortly after it publicly blew up, Sellers was out. Dean William Treanor said:

I informed Professor Sellers that I was terminating her relationship with Georgetown Law effective immediately. During our conversation, she told me that she had intended to resign. As a result of my decision, Professor Sellers is no longer affiliated with Georgetown Law.

For his role in the scandal, Batson was placed on administrative leave pending an investigation by the Office of Diversity, Equity and Affirmative Action, and the Black Law Student Association at Georgetown demanded, inter alia, a “public apology from Professor David Batson in his failure to adequately condemn Sellers’ statements.”

Now we’ve learned Batson has issued that apology, and decided to resign from his role at Georgetown Law. In his resignation letter, available in full below, Batson apologizes for not forcefully denouncing Sellers’s comments in real time:

I understand, however, that I missed the chance to respond in a more direct manner to address the inappropriate content of those remarks. For this I sincerely apologize. This experience has provided me, and I hope others, an invaluable opportunity to reconsider what actions should be taken when we encounter sensitive remarks.

In her own resignation letter, Sellers also offers an apology and says she’s committed to doing what she can to “combat racism in the Georgetown community.”

I am deeply sorry for my hurtful and misdirected remarks. While the video of this incident is an excerpt from a longer discussion about class participation patterns not overall grades, it doesn’t diminish the insensitivity I have demonstrated. I would never do anything to intentionally hurt my students or Georgetown Law and wish I could take back my words. Regardless of my intent, I have done irreparable harm and I am truly sorry for this. For that reason, I am immediately and voluntarily resigning my position as an adjunct professor.

You can read both the resignations below.

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Kathryn Rubino is a Senior Editor at Above the Law, and host of The Jabot podcast. AtL tipsters are the best, so please connect with her. Feel free to email her with any tips, questions, or comments and follow her on Twitter (@Kathryn1).

“I’m not saying Hitler did nothing wrong, but did he do anything wrong?” accused Capitol rioter Timothy Hale-Cusinelli wondered on a February 2020 podcast. After January 6, he pulled that one off of YouTube and attempted to delete the pictures of himself sporting a distinctive mustache from his phone.

But he couldn’t delete his coworkers’ memories of the time he showed up at work LARPing as a Nazi. Ditto for his habit of asking all new hires if they were Jewish.

Thirty-three of Hale-Cusinelli’s coworkers told the FBI under oath that he was a virulently anti-semitic white supremacist who promised to leave his job “in a blaze of glory.” And while it’s not illegal to be a bigot, it probably won’t help bolster the claim that fomenting a race war and overthrowing the federal government was the farthest thing from Hale-Cusinelli’s mind as he directed a stream of protestors around the Capitol.

Hale-Cusinelli, a member of the United States Army Reserve and security contractor at Naval Weapons Station Earle, admitted to the FBI and Naval Criminal Investigation Services that he was at the Capitol on January 6 to stop Congress from certifying President Biden’s electoral win. He was recorded by an FBI informant rhapsodizing about “the adrenaline, the rush, the purpose” that he felt during the invasion and his regret that more “patriots” hadn’t been there to take over congress.

Defendant stated that it was “only a matter of time” before a civil war broke out “along partisan lines,” but that “they” don’t want to fire the first shot because all of the guns and resources are in Republican hands, and Republicans make up 70% of the military. Defendant then said that, in the event of civil war, “it’s not going to be New York and California winning the day, it’s going to be the good old boys from the Midwest, Texas, and Arkansas.” Defendant told CHS that he “really wishes” there would be a civil war. When CHS interrupted and said “but a lot of people would die,” Defendant replied “Thomas Jefferson said the tree of liberty should be refreshed with the blood of patriots and tyrants.”

A letter to the court from his supervisor saying that Hale-Cusinelli is a stand-up, not at all racist guy was contradicted by the supervisor’s own testimony to the FBI that he’d had to tell the defendant to quit being such a racist asshole at work.

And Hale-Cusinelli wants to be released into the care of a guy who got arrested with him in 2010 for “using a ‘potato gun’ made out of PVC pipe to shoot frozen corn at houses in Howell, New Jersey. The ‘potato gun’ was emblazoned with the words ‘WHITE IS RIGHT’ and a drawing of a confederate flag.” Alternatively, he’d like to be supervised by a female friend who appears to have engineered the false letter from Hale-Cusinelli’s supervisor and spends lots of time LOLing at his Hitler role play selfies and plans to destroy evidence.

This amazing correction the defendant’s lawyers were forced to make to the court records on March 2 is really the cherry on top.

A representation was made by a family member that Defendant was offered an honorable discharge from military service however, it has come to counsel’s attention that this was a mistaken representation and is not accurate. Defendant submits this correction to the Court.

Mistakes were made.

Perhaps it was a strategic error to boast that he could not possibly have been intending to commit crimes on January 6 because he “got dressed up in a suit and tie for the occasion,” when the government claims that “he hid the suit and tie that he wore to the Capitol at an undisclosed location before he was arrested; and he discussed with [the FBI informant] his intent to destroy additional evidence so as not to be arrested with it.”

Whether this will persuade the court to overrule the magistrate and order Hale-Cusinelli held in custody pending trial remains to be seen. The government urges U.S. District Judge Trevor N. McFadden to follow the precedents set by Judges Howell, Lamberth, and Kelly, his fellows on the federal bench in DC, and treat the invasion of the Capitol as inherently different from other crimes similarly charged.

Will Judge McFadden agree with his fellow Trump appointee Judge Thomas Kelly, who referred to the events on January 6 as a “unique attack on the crown jewels of our country, the peaceful transfer of power” when he overruled the magistrate to hold Proud Boy Dominic Pezzola in custody?

We’ll find out on March 23 when Hale-Cusinelli has his next hearing to determine whether he’ll be sporting his Nazi stache at home or as a guest of the federal government.

United States v. HALE-CUSANELLI (1:21-cr-00037) [Docket via Court Listener]

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Elizabeth Dye lives in Baltimore where she writes about law and politics.

In March 2020, I found myself locked inside a tiny bathroom, participating on an important conference call while my toddler banged frantically on the other side of the door. As I tried to time my participation—including careful use of the “unmute” button—opposite his interruptions, it began to set in just how challenging trying to make partner while working remotely would be.

I was suddenly responsible for so many tasks I’d previously had more help with, including daytime childcare, cooking, and cleaning. If someone had told me then that I’d succeed in making partner at the end of the year, I would have laughed.

— Sara E. Margolis, a new partner in the New York office of MoloLamken, detailing the trials and travails she experienced as she attempted to make partner at her firm during the pandemic.

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Staci Zaretsky is a senior editor at Above the Law, where she’s worked since 2011. She’d love to hear from you, so please feel free to email her with any tips, questions, comments, or critiques. You can follow her on Twitter or connect with her on LinkedIn.