Suzanne York

Medicare Advantage plans are concerned that the Centers for Medicare & Medicaid Services’ (“CMS”) final Risk Adjustment Validation Rule (“RAVR”), which is expected to be published on February 1, 2023, will be used to seek millions of dollars in retrospective adjustments going back to 2011. Medicare Advantage plans have been highly profitable for private health […]

On January 17, 2023, the Centers for Medicare & Medicaid Services (CMS) held a roundtable with provider groups on improving the prior authorization process in governmental programs such as Medicare Advantage, Medicaid, and exchange plans under the Affordable Care Act. Providers have long complained that health insurers’ prior authorization processes unnecessarily delay patient care and

Following several quarters of strong profits, UnitedHealth Group (“United”) again reported strong profits for the fourth quarter of 2022, with double-digit growth at both UnitedHealthcare and Optum. United’s fourth quarter results again beat analysts’ expectations. United posted profits of $4.8 billion for the fourth quarter, up from $4.1 billion for the fourth quarter in 2021.

The Center for Healthcare Quality and Payment Reform (“CHQPR”) has issued an alarming report finding that more than 600 rural hospitals – nearly 30% of the country’s total – are at risk of closing in the near future. Of these, over 200 are at risk of immediate closure. This continues a trend that began before

The Federal Trade Commission (“FTC”) has proposed a rule that would, in its words, “categorically” ban non-compete clauses in labor contracts. Non-compete clauses are terms in labor agreements that prevent a worker from accepting employment with a competitor or starting a competing business after leaving an employer, generally for a certain period of time and

Non-compete clauses are increasingly common in healthcare provider contracts.  Non-compete clauses present numerous legal issues, including their scope and enforceability as both the federal and state governments enact laws and policies governing their use. The attorneys at Whatley Kallas, LLP are keeping up-to-date with this changing legal landscape.  Whatley Kallas Of Counsel Deborah Winegard recently

Humana, Inc. and Cigna Corporation both reported strong third quarter 2022 profits due to lower than expected payments to medical providers. Humana reported third quarter 2022 profits of $1.2 billion, beating analysts’ expectations. Humana also reported strong third quarter 2022 revenues of $22.8 billion, up by 10.2% from the third quarter of 2021. In announcing

Whatley Kallas is investigating practices by Bayer, the manufacturer of Advantix- and Advantage-branded flea medications for pets, that have allowed Bayer to maintain a monopoly position over the market for veterinary topical flea medications. These practices, and Bayer’s resulting monopoly power, have caused consumers to pay at least tens of millions of dollars more for

Elevance Health (formerly known as Anthem) reported strong profits of $1.6 billion for the third quarter of 2022, an increase of 7.2% over the prior year quarter. Elevance Health’s operating revenues were also sharply up, growing 11.5% over the prior year quarter to $39.9 billion. Both Elevance Health’s third quarter profits and revenues beat analysts’