In an article entitled How Medicare Advantage plans wrongly deny prior auth requests, the American Medical Association highlights findings from a recent Department of Health and Human Services Office of the Inspector General Report. The OIG Report found that 13% of the sampled prior authorization requests denied by Medicare Advantage plans met Medicare’s clinical coverage …
On May 5, 2022, a member of Partnership HealthPlan of California (“PHC”) filed a class action lawsuit in Humboldt County Superior Court challenging PHC’s failure to adequately store and protect sensitive medical information of up to 850,000 enrollees. Among other things, the Complaint alleges violations of the Information Practices Act of 1977; the Confidentiality of …
The Department of Health and Human Services Office of the Inspector General (OIG) has issued a report entitled Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care (“the Report”). The OIG conducted its investigation as a result of its concern that the government’s payment to Medicare …
On March 25, 2022, SuperCare Health (“SuperCare”) reported that from July 23 to July 27, 2021, an unknown party had access to certain computer systems on the SuperCare network. The company reported on February 4, 2022 that some consumer information was potentially accessed, but did not reveal until March 25, 2022, that the incident had …
Anthem, Inc. reported strong profits of $2.4 billion for the first quarter of 2022, an increase of 13.2% over the prior year quarter. Anthem’s operating revenues were also sharply up, growing 18% over the prior year quarter to $37.9 billion. Anthem’s adjusted net income was $8.25 per share, beating analysists’ expectations. In addition, Anthem reported …
ANTHEM POSTS STRONG FIRST QUARTER 2022 PROFITS, BEATING ANALYSTS’ EXPECTATIONS Read More »
An investigative report by WRAL in Durham, North Carolina has reported that despite the Pandemic, Blue Cross and Blue Shield of North Carolina (BCBSNC) has reported strong profits and has paid its top executives millions in bonuses. In 2021, BCBSNC, a not-for-profit corporation, reported annual revenue of $10.7 billion and net revenue or profit of …
DESPITE THE PANDEMIC BLUE CROSS BLUE SHIELD EXECUTIVES PAID MILLIONS IN BONUSES Read More »
On March 29, 2022, the Hive ransomware group posted a message on its HiveLeaks darkweb site declaring the group had been able to access the personal private information of approximately 850,000 patients of healthcare coverage provider PARTNERSHIP HEALTHPLAN OF CALIFORNIA. This data included names, addresses and Social Security Numbers of their patients. This breach was reportedly first detected …
The attorneys of Whatley Kallas, LLP congratulate Andra K. Heller on her appointment as the new Senior Vice President and General Counsel of the American Medical Association. Ms. Heller most recently served as associate general counsel at IBM and general counsel of the IBM Watson Health Business. In announcing the appointment, AMA Chief Executive Officer …
On February 24, 2022, the United States Department of Justice, along with the states of Minnesota and New York, filed suit in the United States District Court for the District of Columbia seeking to enjoin UnitedHealth Group’s (“United”) proposed acquisition of Change Healthcare, Inc. (“Change”). United owns the country’s largest health insurer and Change is …
In a strongly worded, well-reasoned opinion supported by ample precedent, Judge Jeremy D. Kernodle of the United States District Court of the Eastern District of Texas struck down the sections of the No Surprises Act (“the Act”) rules governing how arbitrators are to determine the amount paid to out-of-network providers. The rules had been challenged …