Suzanne York

Centene Corporation has reported strong first quarter 2023 profits, with profits of $1.1 billion, up from $849 million from the prior year quarter. Centene also reported strong revenue growth, with revenues of 38.9 billion in the first quarter of 2023, up from $37.2 billion in the prior year quarter. Centene’s membership was also sharply up.  […]

Humana, Inc. has reported strong first quarter 2023 profits of $1.24 billion, up from $930 million in the prior year quarter, a 33.1% increase. Humana also reported strong revenues of $26.7 billion for the first quarter, an increase of 12% from the first quarter of 2022.  Humana’s first quarter profits equate to $9.38 a share,

Elevance Health, Inc. (formerly known as Anthem) reported strong first quarter 2023 profits with double-digit growth in profits, operating revenue, and adjusted earnings per share.  Elevance reported profits of $2 billion, an increase of 11% over the prior year quarter’s profits. Elevance’s first quarter operating revenues were also sharply up, growing 10.5% over the prior

In the wake of the tragic mass shooting in Dadeville, Alabama, 15 of the gunshot victims were brought by ambulance and private vehicle to Lake Martin Community Hospital in Dadeville for treatment.  Thanks to the extraordinary work of Lake Martin Community Hospital and its doctors, nurses and staff, six of those patients have been treated

Following strong profits in 2022, UnitedHealth Group (“United”) again reported strong profits for the first quarter of 2023, with double-digit revenue growth at both UnitedHealthcare and Optum.  UnitedHealthcare’s first quarter revenue growth was 13% and Optum’s first quarter revenue growth was 25%. United’s first quarter results again beat analysts’ expectations. United posted profits of $5.62

The Centers for Medicare & Medicaid Services has finalized its rules governing Medicare Advantage plans.  Of greatest importance to providers are the changes to the rules governing Medicare Advantage plans’ coverage and medical necessity determinations. As stated in the rules’ preamble, these changes “will ensure that MA organizations provide equal access to Part A and

The Centers for Medicare & Medicaid Services has issued its final rules for payments to Medicare Advantage plans for Calendar Year 2024.  The final rules phase in changes to the determination of risk adjustment payments to the Medicare Advantage plans intended to reduce overbilling by these plans.  Medicare Advantage plans are among the most profitable

Senator Elizabeth Warren (D-MA) has sent a letter to the Federal Trade Commission asking it to carefully scrutinize CVS Health’s proposed acquisition of Oak Street Health.

ProPublica has published its investigation into Cigna’s system for denying payment for claims as not medically necessary without review by a medical director in order to save itself millions of dollars. The report highlights the experience of one patient for whom Cigna denied payment for a blood test as not medically necessary – even though

On March 17, 2023, the Centers for Medicare & Medicaid Services issued new guidance for the Independent Dispute Resolution (“IDR”) process under the No Surprises Act for payment determinations made on or after February 6, 2023 for services provided after October 25, 2022.  The new guidance was issued in light of federal court decisions striking