Becky Kirby

HHS AUDIT FINDS THAT THE MEDICARE PROGRAM OVERPAID CIGNA-HEALTHSPRING OF TENNESSEE $5.9 MILLION DUE TO CIGNA’S SUBMISSION OF PATIENT DIAGNOSIS CODES NOT SUPPORTED BY MEDICAL RECORDS

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 …

HHS AUDIT FINDS THAT THE MEDICARE PROGRAM OVERPAID CIGNA-HEALTHSPRING OF TENNESSEE $5.9 MILLION DUE TO CIGNA’S SUBMISSION OF PATIENT DIAGNOSIS CODES NOT SUPPORTED BY MEDICAL RECORDS Read More »

PATRICK SHEEHAN SPEAKS ON TELEHEALTH COVERAGE ISSUES AT THE MASSACHUSETTS BAR ASSOCIATION’S 2022 HEALTH LAW CONFERENCE

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 …

PATRICK SHEEHAN SPEAKS ON TELEHEALTH COVERAGE ISSUES AT THE MASSACHUSETTS BAR ASSOCIATION’S 2022 HEALTH LAW CONFERENCE Read More »

ANTHEM (ELEVANCE HEALTH) POSTS STRONG SECOND QUARTER 2022 PROFITS, BEATING ANALYSTS’ EXPECTATIONS

Anthem, Inc., now known as Elevance Health, reported strong profits of $2.4 billion for the second quarter of 2022, an increase of 13.7% over the prior year quarter. Anthem’s operating revenues were also sharply up, growing 15.6% over the prior year quarter to $38.5 billion. Anthem’s adjusted net income was $8.04 per share, beating analysists’ …

ANTHEM (ELEVANCE HEALTH) POSTS STRONG SECOND QUARTER 2022 PROFITS, BEATING ANALYSTS’ EXPECTATIONS Read More »

UNITEDHEALTH GROUP’S LOWER THAN EXPECTED MEDICAL COSTS CONTRIBUTED TO ITS STRONG SECOND QUARTER PROFITS, BEATING ANALYSTS’ EXPECTATIONS

UnitedHealth Group’s second quarter 2022 earnings report showed that its medical care ratio (MCR) was 81.5%, lower than its expected MCR of 83%. An insurer’s MCR, which is frequently referred as the medical loss ratio, represents the insurer’s spending on claims compared with its earnings from premiums. United’s lower than expected MCR means that it …

UNITEDHEALTH GROUP’S LOWER THAN EXPECTED MEDICAL COSTS CONTRIBUTED TO ITS STRONG SECOND QUARTER PROFITS, BEATING ANALYSTS’ EXPECTATIONS Read More »

SUPREME COURT OVERTURNS MEDICARE RULE THAT SIGNIFICANTLY REDUCED PAYMENTS TO 340B HOSPITALS FOR OUTPATIENT DRUGS

On June 15, 2022, the Supreme Court issued a unanimous ruling in American Hospital Association et al. v. Becerra, overturning Medicare rules that significantly reduced payments to 340B hospitals for outpatient drugs. The specific issue in the case was whether the Department of Health and Human Services had the authority under the Medicare Prescription Drug, …

SUPREME COURT OVERTURNS MEDICARE RULE THAT SIGNIFICANTLY REDUCED PAYMENTS TO 340B HOSPITALS FOR OUTPATIENT DRUGS Read More »

AMA ARTICLE HIGHLIGHTS OIG FINDINGS THAT MEDICARE ADVANTAGE PLANS DELAY AND DENY PATIENTS’ ACCESS TO CARE

In an article entitled How Medicare Advantage plans wrongly deny prior auth requests, the American Medical Association highlights findings from a recent Department of Health and Human Services Office of the Inspector General Report. The OIG Report found that 13% of the sampled prior authorization requests denied by Medicare Advantage plans met Medicare’s clinical coverage …

AMA ARTICLE HIGHLIGHTS OIG FINDINGS THAT MEDICARE ADVANTAGE PLANS DELAY AND DENY PATIENTS’ ACCESS TO CARE Read More »

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