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NY ATTORNEY GENERAL SUES CVS, ALLEGING THAT IT HARMS SAFETY NET HOSPITALS AND PATIENTS BY DIVERTING MILLIONS FROM UNDERSERVED COMMUNITIES TO CVS

New York’s Attorney General, Letitia James, has sued CVS Health Corp., alleging that it violated New York’s antitrust laws and abused its market power by illegally requiring safety net hospitals that contract with CVS pharmacies for dispensing 340B outpatient drugs to exclusively use CVS’s subsidiary Wellpartner as their Third Party Administrator (“TPA”) for the 340B […]

NY ATTORNEY GENERAL SUES CVS, ALLEGING THAT IT HARMS SAFETY NET HOSPITALS AND PATIENTS BY DIVERTING MILLIONS FROM UNDERSERVED COMMUNITIES TO CVS Read More »

HUMANA REPORTS STRONG SECOND QUARTER PROFITS AND INCREASES ITS ANNUAL PROFIT FORECAST DUE TO LOWER MEDICAL COSTS

Humana, Inc. has reported strong second quarter profits of $696 million, bringing its profits for the first half of the year to $1.6 billion, an increase of 14.8% from the first half of 2021.  Humana also reported strong revenues of $23.7 billion for the second quarter, an increase of 14.6% from the second quarter of

HUMANA REPORTS STRONG SECOND QUARTER PROFITS AND INCREASES ITS ANNUAL PROFIT FORECAST DUE TO LOWER MEDICAL COSTS Read More »

ANTHEM (ELEVANCE HEALTH) POSTS STRONG SECOND QUARTER 2022 PROFITS, BEATING ANALYSTS’ EXPECTATIONS

Anthem, Inc., now known as Elevance Health, reported strong profits of $2.4 billion for the second quarter of 2022, an increase of 13.7% over the prior year quarter. Anthem’s operating revenues were also sharply up, growing 15.6% over the prior year quarter to $38.5 billion. Anthem’s adjusted net income was $8.04 per share, beating analysists’

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

UNITEDHEALTH GROUP’S LOWER THAN EXPECTED MEDICAL COSTS CONTRIBUTED TO ITS STRONG SECOND QUARTER PROFITS, BEATING ANALYSTS’ EXPECTATIONS

UnitedHealth Group’s second quarter 2022 earnings report showed that its medical care ratio (MCR) was 81.5%, lower than its expected MCR of 83%. An insurer’s MCR, which is frequently referred as the medical loss ratio, represents the insurer’s spending on claims compared with its earnings from premiums. United’s lower than expected MCR means that it

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

UNITEDHEALTH GROUP REPORTS STRONG PROFITS FOR THE SECOND QUARTER OF 2022, BEATING ANALYSTS’ EXPECTATIONS

UnitedHealth Group reported strong profits for the second quarter of 2022, with double digit growth at both UnitedHealthcare and Optum. UnitedHealth Group’s strong second quarter profits beat analysts’ expectations. UnitedHealth Group posted profits of $5.1 billion for the second quarter, up from $4.3 billion for the second quarter in 2021.  UnitedHealth Group also posted revenues

UNITEDHEALTH GROUP REPORTS STRONG PROFITS FOR THE SECOND QUARTER OF 2022, BEATING ANALYSTS’ EXPECTATIONS Read More »

AHA URGES CONGRESS TO INCREASE ITS OVERSIGHT OVER MEDICARE ADVANTAGE PLANS

In a strongly worded letter in advance of a Congressional hearing on Medicare Advantage plans, the American Hospital Association urged Congress to increase its oversight over these plans, stating: “strong, decisive, and immediate enforcement action is needed to protect sick and elderly patients, the providers who care for them, and American taxpayers….” In support of

AHA URGES CONGRESS TO INCREASE ITS OVERSIGHT OVER MEDICARE ADVANTAGE PLANS Read More »

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 »

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