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THE SUPREME COURT SUPPORTS HHS’S RULES GOVERNING CALCULATION OF DSH ADJUSTMENTS TO HOSPITALS SERVING LOW-INCOME PATIENTS

On June 24, 2022, in Becerra v. Empire Health Foundation, the Supreme Court upheld the Department of Health and Human Services’ interpretation of the Medicare statute governing how disproportionate share adjustments are calculated for hospitals serving low-income patients. The interpretation upheld by the Court generally reduces the payments available to these hospitals. The case involved …

THE SUPREME COURT SUPPORTS HHS’S RULES GOVERNING CALCULATION OF DSH ADJUSTMENTS TO HOSPITALS SERVING LOW-INCOME PATIENTS Read More »

SUPREME COURT OVERTURNS MEDICARE RULE THAT SIGNIFICANTLY REDUCED PAYMENTS TO 340B HOSPITALS FOR OUTPATIENT DRUGS

On June 15, 2022, the Supreme Court issued a unanimous ruling in American Hospital Association et al. v. Becerra, overturning Medicare rules that significantly reduced payments to 340B hospitals for outpatient drugs. The specific issue in the case was whether the Department of Health and Human Services had the authority under the Medicare Prescription Drug, …

SUPREME COURT OVERTURNS MEDICARE RULE THAT SIGNIFICANTLY REDUCED PAYMENTS TO 340B HOSPITALS FOR OUTPATIENT DRUGS Read More »

AHA URGES THE DOJ TO ESTABLISH A TASK FORCE TO CONDUCT FALSE CLAIMS INVESTIGATIONS INTO HEALTH INSURERS’ DENIALS OF PATIENT CARE

In a very strongly worded letter, the American Hospital Association has urged the Department of Justice to establish a task force to conduct False Claims Act investigations into commercial Medicare Advantage insurers that routinely deny patient access to services and deny payments to health care providers. By law, Medicare Advantage plans are prohibited from imposing …

AHA URGES THE DOJ TO ESTABLISH A TASK FORCE TO CONDUCT FALSE CLAIMS INVESTIGATIONS INTO HEALTH INSURERS’ DENIALS OF PATIENT CARE Read More »

MISSISSIPPI TODAY INVESTIGATIVE REPORT FINDS THAT BCBS-MS IS HOLDING “A HUGE PILE OF MONEY” WHILE REFUSING TO PAY MEDICAL PROVIDERS MORE FOR CARE TO ITS MEMBERS

Mississippi Today has published its investigative report regarding Blue Cross and Blue Shield of Mississippi’s (BSBS-MS) “extraordinarily high” cash reserves and changes to its governance structure that have prevented those reserves from being used to reduce premiums or to pay providers more. The report found that BCBS-MS is holding $750 million in cash reserves, at …

MISSISSIPPI TODAY INVESTIGATIVE REPORT FINDS THAT BCBS-MS IS HOLDING “A HUGE PILE OF MONEY” WHILE REFUSING TO PAY MEDICAL PROVIDERS MORE FOR CARE TO ITS MEMBERS Read More »

ANTHEM’S LOWER THAN EXPECTED MEDICAL COSTS CONTRIBUTED TO ITS STRONG FIRST QUARTER PROFITS, BEATING ANALYSTS’ EXPECTATIONS

Anthem’s first quarter 2022 earnings report showed that Anthem’s benefit expense ratio was 86.1%, lower than its expected ratio of 87.8%. An insurer’s benefit expense ratio represents the insurer’s spending on claims compared with its earnings from premiums. Anthem’s lower than expected benefit expense ratio means that it paid less to providers for medical costs …

ANTHEM’S LOWER THAN EXPECTED MEDICAL COSTS CONTRIBUTED TO ITS STRONG FIRST QUARTER PROFITS, BEATING ANALYSTS’ EXPECTATIONS Read More »

WHATLEY KALLAS LLP INVESTIGATING NOTIFICATION OF DATA BREACH INVOLVING HIGHMARK HEALTH VENDOR

On March 10, 2022, Highmark Health, a health services company affiliated with several Blue Cross Blue Shield companies, issued a statement revealing that a subcontractor of one of its mail vendors, Webb Mason Marketing, was involved in a data breach that may have impacted as many as 67,147 Highmark members. According to the notification letter: …

WHATLEY KALLAS LLP INVESTIGATING NOTIFICATION OF DATA BREACH INVOLVING HIGHMARK HEALTH VENDOR Read More »

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