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 …
Truvada is a blockbuster drug used to treat and prevent HIV infection. Manufactured by Gilead Sciences, Truvada is a combination of two patented drugs in one pill. Several generic drug manufacturers challenged the validity of the patents on these drugs, especially one called emtricitabine. Gilead settled all of this litigation, including a case it filed …
JUDGE RULES THAT CLAIMS RELATING TO TRUVADA CAN PROCEED Read More »
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’ …
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 …
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, …
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 …