Suzanne York

AHA URGES THE DOJ TO ESTABLISH A TASK FORCE TO CONDUCT FALSE CLAIMS INVESTIGATIONS INTO HEALTH INSURERS’ DENIALS OF PATIENT CARE

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 […]

AHA URGES THE DOJ TO ESTABLISH A TASK FORCE TO CONDUCT FALSE CLAIMS INVESTIGATIONS INTO HEALTH INSURERS’ DENIALS OF PATIENT CARE Read More »

CLASS ACTION LAWSUIT ALLEGES PARTNERSHIP HEALTHPLAN OF CALIFORNIA ALLOWED DATA OF UP TO 850,000 ENROLLEES TO BE SUBJECT TO RANSOMWARE ATTACK

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

CLASS ACTION LAWSUIT ALLEGES PARTNERSHIP HEALTHPLAN OF CALIFORNIA ALLOWED DATA OF UP TO 850,000 ENROLLEES TO BE SUBJECT TO RANSOMWARE ATTACK Read More »

HHS INSPECTOR GENERAL REPORT FINDS THAT MEDICARE ADVANTAGE PLANS DENIED PRE-AUTHORIZATION REQUESTS AND DENIED PAYMENT FOR MEDICALLY NECESSARY CARE

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

HHS INSPECTOR GENERAL REPORT FINDS THAT MEDICARE ADVANTAGE PLANS DENIED PRE-AUTHORIZATION REQUESTS AND DENIED PAYMENT FOR MEDICALLY NECESSARY CARE Read More »

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

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 LOWER THAN EXPECTED MEDICAL COSTS CONTRIBUTED TO ITS STRONG FIRST QUARTER PROFITS, BEATING ANALYSTS’ EXPECTATIONS

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 »

MEDICAL INFORMATION POTENTIALLY ACCESSED FOR PATIENTS ENROLLED IN SUPERCARE HEALTH IN CALIFORNIA

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

MEDICAL INFORMATION POTENTIALLY ACCESSED FOR PATIENTS ENROLLED IN SUPERCARE HEALTH IN CALIFORNIA Read More »

ANTHEM POSTS STRONG FIRST QUARTER 2022 PROFITS, BEATING ANALYSTS’ EXPECTATIONS

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 »

DESPITE THE PANDEMIC BLUE CROSS BLUE SHIELD EXECUTIVES PAID MILLIONS IN BONUSES

An investigative report by WRAL in Durham, North Carolina has reported that despite the Pandemic, Blue Cross and Blue Shield of North Carolina (BCBSNC) has reported strong profits and has paid its top executives millions in bonuses. In 2021, BCBSNC, a not-for-profit corporation, reported annual revenue of $10.7 billion and net revenue or profit of

DESPITE THE PANDEMIC BLUE CROSS BLUE SHIELD EXECUTIVES PAID MILLIONS IN BONUSES Read More »

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

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 »

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

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 »

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