Suzanne York

The Centers for Medicare & Medicaid Services has finalized its Interoperability and Prior Authorization Rule, which applies, inter alia, to Medicare Advantage plans. Beginning in 2026, Medicare Advantage and other plans subject to the Final Rule will be required to respond to prior authorization requests within 72 hours for expedited (urgent) requests and seven calendar …

CMS FINALIZES INTEROPERABILITY AND PRIOR AUTHORIZATION RULE Read More »

Following strong profits in 2022 and the first three quarters of 2023, UnitedHealth Group (“United”) again reported strong profits for the fourth quarter and full year 2023.  United reported fourth quarter profits of $5.5 billion compared with $4.8 billion from the prior year quarter and revenues of $94.4 billion, up from $82.8 billion from the …

UNITEDHEALTH GROUP REPORTS STRONG PROFITS FOR THE FOURTH QUARTER AND FULL YEAR 2023 Read More »

Bryan Stevenson, the founder of the Equal Justice Initiative, the Legacy Museum, and the National Memorial for Peace and Justice has given an important interview on the state of race in America.  His interview is linked here.

On December 15, 2023, CMS reopened its IDR portal to process all dispute types and granted extensions to certain deadlines.  Specifically, CMS announced: For disputing parties engaged in IDR entity selection for batched disputes when the IDR portal temporarily closed, the deadline for selecting a certified IDR entity is December 29, 2023. Disputing parties with …

CMS HAS REOPENED THE NO SURPRISES ACT IDR PORTAL FOR ALL DISPUTES Read More »

Patients with Humana’s Medicare Advantage plan have recently filed a class action suit in federal court for the Western District of Kentucky alleging that Humana “systematically denies” medically necessary rehabilitation care based on an algorithm using artificial intelligence. The lawsuit alleges that Humana used naviHealth’s nh Predict platform to make coverage determinations for long-term rehabilitation …

PATIENTS FILE LAWSUITS AGAINST HUMANA AND UNITED’S MEDICARE ADVANTAGE PLANS FOR DENYING CARE BASED ON AI ALGORITHMS Read More »

In a strongly worded letter to the Centers for Medicare & Medicaid Services and the Federal Trade Commission, four patient advocacy groups are seeking urgent action to address UnitedHealthcare’s “misleading advertising” directed at low-income Connecticut residents who are dually eligible for Medicare and Medicaid.  The letter alleges that the advertisements “fraudulently induce these vulnerable individuals” …

PATIENT GROUPS SEEK URGENT ACTION FROM CMS AND THE FTC TO ADDRESS UNITED’S ALLEGEDLY DECEPTIVE MEDICARE ADVANTAGE MARKETING Read More »

In strongly worded letters, the American Hospital Association (AHA) and the Federation of American Hospitals (FAH) ask the Centers for Medicare & Medicaid Services (CMS) “to conduct rigorous oversight” and to enforce its new rules governing Medicare Advantage (MA) plans in light of recently adopted MA plan policies that AHA and FAH believe violate the …

THE AHA AND FAH URGE CMS TO ENFORECE NEW MEDICARE ADVANTAGE RULES IN LIGHT OF RECENT MA PLAN POLICIES THAT AHA AND FAH BELIEVE VIOLATE THE RULES Read More »

The Washington Post has published an article headlined “Hospitals and Doctors are Fed Up with Medicare Advantage,” which reports on increasing provider complaints with Medicare Advantage plans’ claim denials and onerous preapproval requirements. The article quotes Chip Kahn, the president and CEO of the Federation of American Hospitals as saying:  “The insurance companies running the …

WASHINGTON POST ARTICLE HEADLINED “HOSPITALS AND DOCTORS ARE FED UP WITH MEDICARE ADVANTAGE” REFLECTS THE EXPERIENCE OF WHATLEY KALLAS’S PROVIDER CLIENTS Read More »

Patient data has been exposed in a recently announced security breach impacting over 800,000 patients, including members of Blue Cross and Blue Shield of Massachusetts (BCBSMA).  This breach included full names, email addresses, physical addresses, and telephone numbers. Social Security numbers (SSNs), health insurance and medical ID numbers, dates of service, treatment and diagnostic codes, …

NASCO ANNOUNCES DATA BREACH AFFECTING OVER 800,000 BLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS PATIENTS Read More »

Patient data has been exposed in a recently announced security breach impacting almost 8.5 million patients, including members of several Blue Cross and Blue Shield health plans.  This breach included full names, email addresses, physical addresses, and telephone numbers. For some, it also includes Social Security Numbers (SSNs), Medicare/Medicaid ID numbers, and other health insurance …

WELLTOK ANNOUNCES DATA BREACH AFFECTING HEALTH PLANS, INCLUDING SOME BLUE CROSS AND BLUE SHIELD PLANS Read More »