We congratulate our friend and co-counsel Fred Gray on receiving the Presidential Medal of Freedom. Fred began his distinguished legal career by representing Rosa Parks and Dr. Martin Luther King, Jr. and has continued to handle other important civil rights and other cases through eight decades. Attorneys at WhatleyKallas are proud to have worked with […]
FRED GRAY AWARDED PRESIDENTIAL MEDAL OF FREEDOM Read More »
In a strongly worded letter in advance of a Congressional hearing on Medicare Advantage plans, the American Hospital Association urged Congress to increase its oversight over these plans, stating: “strong, decisive, and immediate enforcement action is needed to protect sick and elderly patients, the providers who care for them, and American taxpayers….” In support of
AHA URGES CONGRESS TO INCREASE ITS OVERSIGHT OVER MEDICARE ADVANTAGE PLANS Read More »
On June 24, 2022, in Becerra v. Empire Health Foundation, the Supreme Court upheld the Department of Health and Human Services’ interpretation of the Medicare statute governing how disproportionate share adjustments are calculated for hospitals serving low-income patients. The interpretation upheld by the Court generally reduces the payments available to these hospitals. The case involved
In a very strongly worded letter, the American Hospital Association has urged the Department of Justice to establish a task force to conduct False Claims Act investigations into commercial Medicare Advantage insurers that routinely deny patient access to services and deny payments to health care providers. By law, Medicare Advantage plans are prohibited from imposing
On May 5, 2022, a member of Partnership HealthPlan of California (“PHC”) filed a class action lawsuit in Humboldt County Superior Court challenging PHC’s failure to adequately store and protect sensitive medical information of up to 850,000 enrollees. Among other things, the Complaint alleges violations of the Information Practices Act of 1977; the Confidentiality of
The Department of Health and Human Services Office of the Inspector General (OIG) has issued a report entitled Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care (“the Report”). The OIG conducted its investigation as a result of its concern that the government’s payment to Medicare
Mississippi Today has published its investigative report regarding Blue Cross and Blue Shield of Mississippi’s (BSBS-MS) “extraordinarily high” cash reserves and changes to its governance structure that have prevented those reserves from being used to reduce premiums or to pay providers more. The report found that BCBS-MS is holding $750 million in cash reserves, at
Anthem’s first quarter 2022 earnings report showed that Anthem’s benefit expense ratio was 86.1%, lower than its expected ratio of 87.8%. An insurer’s benefit expense ratio represents the insurer’s spending on claims compared with its earnings from premiums. Anthem’s lower than expected benefit expense ratio means that it paid less to providers for medical costs
On March 25, 2022, SuperCare Health (“SuperCare”) reported that from July 23 to July 27, 2021, an unknown party had access to certain computer systems on the SuperCare network. The company reported on February 4, 2022 that some consumer information was potentially accessed, but did not reveal until March 25, 2022, that the incident had
Anthem, Inc. reported strong profits of $2.4 billion for the first quarter of 2022, an increase of 13.2% over the prior year quarter. Anthem’s operating revenues were also sharply up, growing 18% over the prior year quarter to $37.9 billion. Anthem’s adjusted net income was $8.25 per share, beating analysists’ expectations. In addition, Anthem reported
ANTHEM POSTS STRONG FIRST QUARTER 2022 PROFITS, BEATING ANALYSTS’ EXPECTATIONS Read More »