Suzanne York

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  The withdrawn policy statements are: Statements of Antitrust Enforcement Policy in Health Care (August 1, 1996)  Statement of Antitrust Enforcement Policy Regarding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)

Following strong profits in 2022 and in the first quarter of 2023, UnitedHealth Group (“United”) again reported strong profits for the second quarter of 2023, with double-digit revenue growth at both UnitedHealth and Optum.  United’s second quarter results once again beat analysts’ expectations. In a press release, United stated “strong and well-balanced growth continued across

In its July 2023 issue, linked here, Florida Trend recognizes Aaron Podhurst, of Podhurst Orseck, as a Legal Lion.  The 8-page profile of Aaron tells the story of Aaron’s life and dedication to the practice of law.  From growing up in the Catskills of New York, to representing victims of air disasters, healthcare providers against

A settlement has been reached in a lawsuit affecting consumers enrolled in two California state-sponsored health care programs for individuals living with HIV.  Notice of the Settlement was mailed on June 16, 2023. The settlement addresses an alleged unauthorized disclosure of protected health information, including HIV status, by certain defendants as part of the California Department of

Cigna has announced a delay in implementing a policy that would have required physicians to submit clinical documentation whenever they submit a claim with certain Evaluation and Management (“E/M”) CPT® codes appended with a modifier 25. Modifier 25 is used to indicate that a patient’s condition requires a significant, separately identifiable E/M service on the