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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

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

 The Department of Justice’s Antitrust Division has withdrawn three antitrust policy statements related to enforcement in healthcare markets.  The withdrawn policy statements are: Department of Justice and FTC Antitrust Enforcement Policy Statements in the Health Care Area (September 15, 1993) Statements of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

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

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

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

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.

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

The Federal Trade Commission (“FTC”) has proposed a rule that would, in its words, “categorically” ban non-compete clauses in labor contracts. Non-compete clauses are terms in labor agreements that prevent a worker from accepting employment with a competitor or starting a competing business after leaving an employer, generally for a certain period of time and

Non-compete clauses are increasingly common in healthcare provider contracts.  Non-compete clauses present numerous legal issues, including their scope and enforceability as both the federal and state governments enact laws and policies governing their use. The attorneys at Whatley Kallas, LLP are keeping up-to-date with this changing legal landscape.  Whatley Kallas Of Counsel Deborah Winegard recently