Suzanne York

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 …

MISSISSIPPI TODAY INVESTIGATIVE REPORT FINDS THAT BCBS-MS IS HOLDING “A HUGE PILE OF MONEY” WHILE REFUSING TO PAY MEDICAL PROVIDERS MORE FOR CARE TO ITS MEMBERS Read More »

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 …

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

On March 10, 2022, Highmark Health, a health services company affiliated with several Blue Cross Blue Shield companies, issued a statement revealing that a subcontractor of one of its mail vendors, Webb Mason Marketing, was involved in a data breach that may have impacted as many as 67,147 Highmark members. According to the notification letter: …

WHATLEY KALLAS LLP INVESTIGATING NOTIFICATION OF DATA BREACH INVOLVING HIGHMARK HEALTH VENDOR Read More »

The Office of the Inspector General of the Department of Health and Human Services has issued a report entitled “Some Medicare Advantage Companies Leveraged Chart Reviews and Health Risk Assessments to Disproportionately Drive Payments.” The OIG undertook the review due to concerns that Medicare Advantage (MA) plans “may leverage both chart reviews and Health Risk …

OIG ISSUES REPORT FINDING THAT SOME MEDICARE ADVANTAGE COMPANIES USED CHART REVIEWS AND HEALTH RISK ASSESSMENTS TO DISPROPORTIONATELY INCREASE RISK ADJUSTMENT PAYMENTS Read More »

The Department of Health and Humana Services Office of the Inspector General has issued a report estimating that the Medicare program made $2.6 billion in risk adjustment payments to Medicare Advantage organizations (“MAOS”) in 2017 based solely on diagnoses reported in Health Risk Assessments (“HRAs”). The OIG further found that 80% of the estimated payments …

OIG REPORT RAISES CONCERNS ABOUT MEDICARE’S PAYMENT OF BILLIONS IN RISK ADJUSTMENT PAYMENTS TO MEDICARE ADVANTAGE PLANS Read More »

On March 28, 2019, Judge John D. Bates, of the United States District Court for the District of Columbia struck down the Trump Administration’s Association Health Plan (AHP) Final Rule. The AHP Final Rule had been designed to allow small employers and individuals to join together to purchase health plans that would be less expensive …

FEDERAL COURT STRIKES DOWN ASSOCIATION HEALTH PLAN RULES Read More »