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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 …

FEDERAL COURT RULES PLAINTIFFS ADEQUATELY ALLEGED CVS ACTED WITH “DELIBERATE INDIFFERENCE” WHEN IT ADOPTED RX PROGRAM THAT DISCRIMINATES AGAINST PEOPLE LIVING WITH HIV Read More »

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 …

ELEVANCE HEALTH (ANTHEM) POSTS A DOUBLE-DIGIT INCREASE IN FIRST QUARTER 2024 PROFITS, BEATING ANALYSTS’ EXPECTATIONS Read More »

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 …

UNITEDHEALTH GROUP REPORTS STRONG REVENUES FOR THE FIRST QUARTER OF 2024 DESPITE CYBERATTACK Read More »

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 …

BECKER’S HEALTHCARE REPORTS THAT HOSPITALS ARE INCREASINGLY HAVING PROBLEMS WITH MEDICARE ADVANTAGE PLANS Read More »

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:  …

NYT INVESTIGATION SHOWS HOW HEALTH INSURERS USE MULTIPLAN TO REDUCE PAYMENTS TO MEDICAL PROVIDERS TO IINCREASE THEIR FEES AND PROFITS AT THE EXPENSE OF PATIENTS Read More »

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 …

MOUNT SINAI HEALTH SYSTEM AND UNITEDHEALTHCARE REACH AN AGREEMENT TO RESOLVE THEIR DISPUTES Read More »

The New York Times has published a video opinion entitled “What’s My Life Worth? The Big Business of Denying Medical Care,” which illustrates how “profit-seeking insurance companies” use the prior authorization process “to create intentional barriers between patients and the healthcare they need.”  As stated in the video: “At best, it’s just a minor bureaucratic …

NYT VIDEO OPINION DEMONSTRATES HOW INSURANCE COMPANIES USE PRIOR AUTHORIZATION TO CAUSE DANGEROUS DELAYS IN PATIENT CARE Read More »

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 …

HEALTHCARE PROVIDERS IMPACTED BY CHANGE DATA BREACH Read More »

A study recently published in JAMA Health Forum found “significant differences in home health service intensity” between patients enrolled in Medicare Advantage plans and patients enrolled in traditional Medicare. The study was entitled “Differences in Home Health Services and Outcome between Traditional Medicare and Medicare Advantage.” Some of its key findings were: Medicare Advantage patients …

STUDY FINDS THAT MEDICARE ADVANTAGE PATIENTS RECEIVE LESS HOME HEALTH CARE THAN PATIENTS WITH TRADITIONAL MEDICARE Read More »

The United States Department of Justice has issued a report listing the settlements and judgments it reached under the False Claims Act for Fiscal Year 2023.  The report includes settlements with Medicare Advantage plans in cases alleging that the plans for knowingly submitting inaccurate information regarding the health status of their beneficiaries to increase their …

THE DEPARTMENT OF JUSTICE REPORTS FALSE CLAIMS ACT RECOVERIES AGAINST MEDICARE ADVANTAGE PLANS IN FISCAL YEAR 2023 Read More »