In a case brought by the Texas Medical Association (“the TMA”) and medical providers, the Fifth Circuit has determined that certain rules governing how the Qualifying Payment Amount (“the QPA”) should be calculated under the No Surprises Act (“the Act”) are contrary to the Act, and therefore should be vacated. The Court also found that […]
Health insurers have continued to report strong revenues and profits for the second quarter of 2026, beating analysts’ expectations. UnitedHealth Group UnitedHealth Group reported profits of $5.5 billion for the second quarter, up sharply from $3.4 billion in profits in the prior year quarter, and revenues of $112 billion. UnitedHealth Group’s performance was driven in
So-called “ghost networks” have emerged as a significant problem in today’s health insurance landscape, particularly in the area of mental health and substance use disorder treatment. A ghost network exists when a health plan’s provider directory lists health professionals who are unavailable, not accepting new patients, no longer in network, or otherwise inaccessible in practice.
CMS is scheduled to award grants to states under the Rural Health Transformation Program on or before December 31, 2025. Although the award of half of the funds was specified by Congress, Congress provided CMS with significant discretion over the remainder – discretion that CMS is using to reward states whose current or future policies
A United States District Court judge for the District of Columbia has granted summary judgment to the government, finding that the Secretary of the Department of Health and Human Services had the discretion to reject Johnson & Johnson’s program to offer rebates instead of discounts to 340B covered entities. In reaching his conclusion, Judge Rudolph
In a victory for providers, the Fifth Circuit Court of Appeals has affirmed the District Court opinion striking down the rules governing how payments for out-of-network payments should be determined in arbitrations under the No Surprises Act. Congress passed the No Surprises Act to prevent patients from being surprised by bills for out-of-network cost sharing
THE FIFTH CIRCUIT AFFIRMS TMA AND PROVIDER WIN STRIKING DOWN NO SURPRISES ACT RULES Read More »
Last Friday, the American Hospital Association released a 9-page report detailing the increasing financial pressures the nation’s hospitals are facing due to rising reimbursement denials and delays from payers, including Medicare Advantage and commercial plans. Among other things, the report — which analyzed data from 1,300 hospitals across the country — found that the median
Former U.S. District Judge U.W. Clemon writes at AL.com that the Supreme Court must be expanded to preserve opportunity for disadvantaged groups. Judge Clemon, a good friend of Whatley Kallas and our frequent co-counsel, movingly describes his own experience: the University of Alabama barred its doors to him as an undergraduate and a law student
JUDGE U.W. CLEMON ADVOCATES FOR SUPREME COURT EXPANSION Read More »
The Office of the Inspector General for the Department of Health and Human Services (“OIG”) has issued a report of its audit of Cigna-HealthSpring of Tennessee’s (“Cigna”) submission of diagnosis codes for its Medicare Advantage members to CMS, which entitled Cigna to additional risk adjustment payments under the Medicare program. The OIG found that the
On September 30, 2022, the Massachusetts Bar Association held its annual Health Law Conference. During the conference, which focused on the rapidly evolving area of telehealth law, Mr. Sheehan spoke about issues concerning telehealth coverage issues developing in the context of commercial insurance. For more information about the conference, and to find out how to