Suzanne York

The Kaiser Family Foundation has reported that the federal government is poised to pay Medicare Advantage plans at least $12.8 billion in quality bonus payments this year, an increase of 30% over 2022.  Annual bonus payments to Medicare Advantage plans have increased every year since 2015. According to the report, UnitedHealthcare will receive $3.9 billion, […]

For the third time, United States District Court Judge Jeremy D. Kernodle of the Eastern District of Texas has struck down certain rules implementing the arbitration process under the No Surprises Act (“the Act”) after a challenge by the Texas Medical Association (“the TMA”). Specifically, the Court struck down CMS guidance increasing the fee for

In its 2023 legislative session, the Colorado General Assembly repealed the state’s previous antitrust law and enacted the Colorado State Antitrust Law of 2023, which has now been signed into law by Governor Jay Polis. The new law provides: Allows any person injured, directly or indirectly, by an antitrust violation to seek an injunction Allows

The Mount Sinai Medical Legal Partnership (“MSMLP”) has opened a legal clinic for Mount Sinai Health System breast cancer patients needing legal assistance to navigate issues arising from their diagnoses, including issues relating to unemployment, housing, social security benefits and end-of-life documents. In a press release, MSMLP’s Executive Director Allison Charney stated: “We want all

The United States Department of Labor has sued UMR, Inc., which serves as a third party administrator for UnitedHealth ERISA-covered plans, for improperly denying claims for emergency department services and for urinary drug screening.  UMR’s parent company is UnitedHealth Group, Inc.  The complaint was filed in the United States District Court for the Western District

The United States Departments of Labor, Health and Human Services, and the Treasury have proposed rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (“the Act”) designed to ensure that health insurance plans comply with the Act’s requirements to provide benefits for mental health and substance use

Elevance Health, Inc. (formerly known as Anthem) reported strong Second quarter 2023 profits with double-digit growth in profits and operating revenue.  Elevance reported profits of $1.9 billion, an increase of 13.2% over the prior year quarter’s profits. Elevance’s second quarter revenues were also sharply up, growing 13% over the prior year quarter to $43.7 billion.

The Department of Labor has submitted proposed rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addition Equity Act of 2008 (“the Act”) to the White House Office of Management and Budget, which is the final stage before proposed rules are published. Health plans covered by the Act are prohibited from placing

In an important decision for membership organizations seeking to challenge unfair business practices under California’s Unfair Competition Law (“UCL”), on July 17, 2023, the California Supreme Court ruled in favor of the California Medical Association (“CMA”), finding that its diversion of resources sufficed to provide standing to challenge a health insurer’s business practices. Specifically, the

The Federal Trade Commission has announced that it is withdrawing two antitrust policy statements related to enforcement in healthcare markets.  The withdrawn policy statements are: Statements of Antitrust Enforcement Policy in Health Care (August 1, 1996)  Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program (October 20, 2011)