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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 […]

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

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

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 Federation of American Hospitals (“FAH”) proposal that CMS add a quality measure to its Medicare Advantage star rating system that would require these plans to report their level 1 prior authorization denial rates has been recommended for approval by an expert panel. The “Level 1 Upheld Denial Rate” proposal is intended to add transparency

Beating analysts’ expectations, the Cigna Group reported strong profits of $1 billion and revenues of $51.1 billion for the fourth quarter of 2023. Fourth quarter revenues were up 12% from $45.8 billion in the prior year quarter. Growth was particularly strong at Cigna Healthcare.  Cigna also reported full year 2023 profits of $5.2 billion and

Elevance Health, Inc. (formerly known as Anthem) reported strong fourth quarter 2023 profits of $856 million and strong fourth quarter revenues of $2.6 billion in revenue, beating analysts’ expectations. Its revenues were up nearly 7% from the prior year quarter. As a result of these strong earnings, Elevance raised its quarterly dividend by 10.1% to

The Centers for Medicare & Medicaid Services has finalized its Interoperability and Prior Authorization Rule, which applies, inter alia, to Medicare Advantage plans. Beginning in 2026, Medicare Advantage and other plans subject to the Final Rule will be required to respond to prior authorization requests within 72 hours for expedited (urgent) requests and seven calendar

Following strong profits in 2022 and the first three quarters of 2023, UnitedHealth Group (“United”) again reported strong profits for the fourth quarter and full year 2023.  United reported fourth quarter profits of $5.5 billion compared with $4.8 billion from the prior year quarter and revenues of $94.4 billion, up from $82.8 billion from the

Bryan Stevenson, the founder of the Equal Justice Initiative, the Legacy Museum, and the National Memorial for Peace and Justice has given an important interview on the state of race in America.  His interview is linked here.