Suzanne York

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: 

On March 19, 2024, New York-based Mount Sinai Health System and UnitedHealthcare announced that they had resolved their disputes and reached agreement on a four-year contract for Mount Sinai’s hospitals and physicians to be in-network with the health insurer. In a statement, Mount Sinai CEO Brendan Carr stated: We are pleased to have reached an

Health care providers nationwide have been impacted with substantial disruptions to the health care services they provide following a February 2024 data breach by Change Healthcare (https://www.changehealthcare.com/), a technology-based subsidiary of United HealthCare. Change serves as an intermediary between health insurance companies, providers and patients, and claims on its website to be “a trusted partner

The Federation of American Hospitals (“FAH”) proposal that CMS add a quality measure to its Medicare Advantage star rating system that would require these plans to report their level 1 prior authorization denial rates has been recommended for approval by an expert panel. The “Level 1 Upheld Denial Rate” proposal is intended to add transparency

Beating analysts’ expectations, the Cigna Group reported strong profits of $1 billion and revenues of $51.1 billion for the fourth quarter of 2023. Fourth quarter revenues were up 12% from $45.8 billion in the prior year quarter. Growth was particularly strong at Cigna Healthcare.  Cigna also reported full year 2023 profits of $5.2 billion and