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CMS HALTS ARBITRATION PROCESS UNDER THE NO SURPRISES ACT AFTER COURT DECISION

The Centers for Medicare & Medicaid Services has ordered an immediate halt to payment decisions by Independent Dispute Resolution (“IDR”) entities under the No Surprises Act as a result of a February 6, 2023 federal court decision vacating the rules governing how out-of-network payment decisions are to be made. In addition, CMS directed IDR entities […]

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CVS HEALTH, WHICH INCLUDES AETNA, REPORTS STRONG FOURTH QUARTER AND FULL YEAR PROFITS

CVS Health has reported strong full year and fourth quarter 2022 profits and revenues, with its health benefits sector Aetna reporting double-digit revenue growth. CVS reported full year profits of $4.1 billion and full year revenues of $322.5 billion, a 10.4% increase from 2021 revenues of $292.1 billion.  CVS also reported strong profits of $2.3

CVS HEALTH, WHICH INCLUDES AETNA, REPORTS STRONG FOURTH QUARTER AND FULL YEAR PROFITS Read More »

HANDING PROVIDERS A WIN, FEDERAL COURT AGAIN STRIKES DOWN NO SURPRISES ACT RULES GOVERNING PAYMENTS TO OUT OF NETWORK PROVIDERS

In a win for providers, the federal court that had previously struck down the sections of the No Surprises Act rules governing how arbitrators determine the amount paid to out-of-network providers, has now struck down the final rules governing these determinations.  The rules had been challenged by the Texas Medical Association, one of its physician

HANDING PROVIDERS A WIN, FEDERAL COURT AGAIN STRIKES DOWN NO SURPRISES ACT RULES GOVERNING PAYMENTS TO OUT OF NETWORK PROVIDERS Read More »

ELEVANCE HEALTH (ANTHEM) POSTS STRONG FULL YEAR 2022 PROFITS, BEATING ANALYSTS’ EXPECTATIONS

Elevance Health, Inc. (formerly known as Anthem) reported strong full year profits of $8.5 billion for 2022, an increase of 12.9% over the prior year. Elevance’s operating revenues were also sharply up, growing 13.7% over the prior year to $156 billion.  As a result, Elevance’s quarterly dividend increased 16% to $148 a share. These results

ELEVANCE HEALTH (ANTHEM) POSTS STRONG FULL YEAR 2022 PROFITS, BEATING ANALYSTS’ EXPECTATIONS Read More »

DOJ WITHDRAWS THREE ANTITRUST POLICY STATEMENTS RELATED TO HEALTHCARE

 The Department of Justice’s Antitrust Division has withdrawn three antitrust policy statements related to enforcement in healthcare markets.  The withdrawn policy statements are: Department of Justice and FTC Antitrust Enforcement Policy Statements in the Health Care Area (September 15, 1993) Statements of Antitrust Enforcement Policy in Health Care (August 1, 1996)  Statement of Antitrust Enforcement

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CIGNA CORPORATION REPORTS STRONG PROFITS FOR THE FOURTH QUARTER AND FULL YEAR OF 2022, BEATING ANALYSTS’ EXPECTATIONS

Beating analysts’ expectations, Cigna reported strong profits of $1.2 billion and revenues of $45.8 billion for the fourth quarter of 2022. Both profits and revenues were up from the prior year quarter in which Cigna reported profits of $1.1 billion and revenues of $45.7 in revenues. For the full year of 2022, Cigna likewise reported

CIGNA CORPORATION REPORTS STRONG PROFITS FOR THE FOURTH QUARTER AND FULL YEAR OF 2022, BEATING ANALYSTS’ EXPECTATIONS Read More »

MEDICARE ADVANTAGE PLANS ARE CONCERNED ABOUT CMS’S EXPECTED RELEASE OF ITS FINAL RISK ADJUSTMENT VALIDATION RULE

Medicare Advantage plans are concerned that the Centers for Medicare & Medicaid Services’ (“CMS”) final Risk Adjustment Validation Rule (“RAVR”), which is expected to be published on February 1, 2023, will be used to seek millions of dollars in retrospective adjustments going back to 2011. Medicare Advantage plans have been highly profitable for private health

MEDICARE ADVANTAGE PLANS ARE CONCERNED ABOUT CMS’S EXPECTED RELEASE OF ITS FINAL RISK ADJUSTMENT VALIDATION RULE Read More »

CMS HOLDS ROUNDTABLE WITH PROVIDER GROUPS TO IMPROVE PRIOR AUTHORIZATION PROCESS FOR MEDICARE ADVANTAGE AND OTHER GOVERNMENT PROGRAMS

On January 17, 2023, the Centers for Medicare & Medicaid Services (CMS) held a roundtable with provider groups on improving the prior authorization process in governmental programs such as Medicare Advantage, Medicaid, and exchange plans under the Affordable Care Act. Providers have long complained that health insurers’ prior authorization processes unnecessarily delay patient care and

CMS HOLDS ROUNDTABLE WITH PROVIDER GROUPS TO IMPROVE PRIOR AUTHORIZATION PROCESS FOR MEDICARE ADVANTAGE AND OTHER GOVERNMENT PROGRAMS Read More »

UNITEDHEALTH GROUP REPORTS STRONG PROFITS FOR THE FOURTH QUARTER AND FULL YEAR OF 2022, BEATING ANALYSTS’ EXPECTATIONS

Following several quarters of strong profits, UnitedHealth Group (“United”) again reported strong profits for the fourth quarter of 2022, with double-digit growth at both UnitedHealthcare and Optum. United’s fourth quarter results again beat analysts’ expectations. United posted profits of $4.8 billion for the fourth quarter, up from $4.1 billion for the fourth quarter in 2021.

UNITEDHEALTH GROUP REPORTS STRONG PROFITS FOR THE FOURTH QUARTER AND FULL YEAR OF 2022, BEATING ANALYSTS’ EXPECTATIONS Read More »

CHQPR REPORTS THAT NEARLY 30% OF THE COUNTRY’S RURAL HOSPITALS ARE AT RISK FOR CLOSURE

The Center for Healthcare Quality and Payment Reform (“CHQPR”) has issued an alarming report finding that more than 600 rural hospitals – nearly 30% of the country’s total – are at risk of closing in the near future. Of these, over 200 are at risk of immediate closure. This continues a trend that began before

CHQPR REPORTS THAT NEARLY 30% OF THE COUNTRY’S RURAL HOSPITALS ARE AT RISK FOR CLOSURE Read More »

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