Liann Gohari, the Vice President and Deputy General Counsel at Health Net Inc., a subsidiary of Centene Corporation has been named as a co-conspirator in a $1.1B lawsuit filed by a mental health care services provider, Sovereign Health Group.
The lawsuit claims that Liann Gohari willingly participated and unlawfully acted in the planning and execution of a malicious conspiracy to drive Sovereign Health Group out of business in 2018 by causing irreparable damage to its reputation with the help of several other accomplices who have also been named in the lawsuit. The full complaint is available here – https://bit.ly/2WHlw15
The lawsuit says that in January 2016, Health Net hired a law firm to collaborate on a strategy regarding the outstanding claims by out-of-network substance abuse providers including Sovereign Health Group. In furtherance of the plan, Liann Gohari, along with the lawyers from the company’s law firm devised a fraudulent scheme to make false accusations against Sovereign and other out-of-network substance abuse providers.
As a part of the scheme, Health Net instituted a special investigation unit (“SIU”) to conduct an “audit” of Sovereign and other substance use disorder treatment centers in California as a pretext for refusing to pay claims. The lawsuit claims that Sovereign and other providers were placed on an SIU “watchlist.”
All claims from providers on the “watchlist” were asked to be re-routed through this SIU audit unit, which led to an exponential increase in the number of claims that Health Net refused to pay. Centene Corporation acquired Health Net in March 2016 and became a part of the elaborate scheme hatched by Liann Gohari with the lawyers of the company’s law firm.
It is alleged that Gohari drafted a boilerplate form letter to more than 1,000 treatment centers designed to hide the blanket policy of refusing to pay certain claims and the policy of indiscriminately rerouting claims to SIU. Gohari caused the letter to bear the signature of Health Net’s Director of SIU, Matthew Ciganek, without Mr. Ciganek’s prior knowledge.
The Ciganek letter imposed unlawful and onerous burdens on providers regarding claim submission, requesting extensive and unusual amounts of documentation in a short time frame making it literally impossible for timely submissions. The letter also stated that Health Net was suspending payment on claims previously submitted and that Health Net was investigating alleged fraudulent practices.
Later on, Liann Gohari and others accused in the lawsuit, participated in making false representations to various lawmakers and federal agencies against Sovereign. They managed to convince some officials and have Sovereign investigated by the FBI through their web of lies so as to tarnish Sovereign’s reputation leading to its closure in 2018.