Suzanne York

The United States Supreme Court has granted certiorari to hear a hospital’s challenge to how the Department of Health and Human Services calculates disproportionate share (“DSH”) payments for hospitals serving low-income patients.  The case, Advocate Christ Medical Center et al. v. Bercerra, involves the statutory interpretation of whether the phrase “entitled…to benefits” means the same […]

Whatley Kallas’s provider clients have been increasingly frustrated with Medicare Advantage plans’ inappropriate denials and reduced payment of claims and with the plans’ use of prior authorization to delay and deny care and we have been pursuing clams based upon those denials and reductions. Congress and the Centers for Medicare & Medicaid Services have also

Lawyers at Whatley Kallas had the good fortune of working together with Ralph Knowles in a number of cases, and our former partner, Jack Drake, was Ralph’s partner for many years.  Ralph was justifiably recognized as a great lawyer and admitted to the Alabama Lawyer Hall of Fame.  One can read about some of Ralph’s

The United States Department of Labor has issued a final rule overturning a Trump Administration policy allowing some small businesses to use Association Health Plans to avoid providing patient protections required by the Affordable Care Act (“ACA”). The now overturned policy allowed certain groups of employers to form associations to offer health insurance coverage that

The Department of Health and Human Services has issued its long-delayed final rule establishing an Administrative Dispute Resolution process (“ADR”) for 340B disputes. The rule allows all 340B covered entities to use the ADR process to bring claims when they have been overcharged by a drug company for 340B drugs, including claims where the 340B

Los Angeles, CA – Late Friday the United States District Court for the Northern District of California ruled that four HIV-positive “John Doe” plaintiffs adequately alleged CVS acted intentionally under the “deliberate indifference” standard when it implemented a drug program that discriminates against people living with HIV. Download the Order here. The latest ruling comes in a

Elevance Health, Inc. (formerly known as Anthem) reported strong first quarter 2024 profits of $2.2 billion, a 12.9% increase from the prior year quarter, beating both analysts’ and Elevance’s internal expectations.  First quarter revenues also increased to $42.6 billion compared to $42.2 billion in the prior year quarter. Elevance also reported that BlueCard membership grew

UnitedHealth Group (“United”) reported strong revenues of $99.8 billion for the first quarter of 2024, growing nearly $8 billion from the prior year quarter.  United’s strong revenues beat analysts’ expectations and caused its stock price to soar by more than 5%.   UnitedHealthcare’s revenues were $75.4 billion in the first quarter, an increase of nearly

In an article entitled “Hospitals’ Medicare Advantage problem hits an inflection point,” Becker’s Healthcare reports on hospitals’ increasing problems with collecting payments from Medicare Advantage plans, to the extent that many hospitals are planning or considering terminating their Medicare Advantage contracts. Chip Kahn, President and CEO of the Federation of American Hospitals, was quoted in

In a front-page investigative report headlined “Patients Hit with Big Bills While Insurers Reap Fees,” the New York Times shows how health insurers use MultiPlan to reduce payments to medical providers, which increases the fees employers pay the insurers and MultiPlan, but which frequently results in higher medical bills for patients. Here’s how it works: