Suzanne York

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 […]

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

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”

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 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

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,

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

Humana, Inc. has reported strong third quarter 2023 earnings, with its adjusted earnings per share of $7.78 beating analysts’ estimates. For the first three quarters of 2023, Humana has earned $3 billion in profit. Humana also announced that it expects to increase its Medicare Advantage membership to 860,000 in 2023, an increase of 19%, and

Beating analysts’ expectations, the Cigna Group reported strong profits of $1.4 billion and revenues of $49 billion for the third quarter of 2023. Through the first nine months of the year, Cigna reported $4.1 billion in profit and $144.2 billion in revenue. Cigna’s revenue growth was particularly strong in its health insurance business, Cigna Healthcare.