HAPPY NEW YEAR FROM WHATLEY KALLAS
The attorneys and staff at Whatley Kallas, LLP want to take a moment to wish our clients and friends a very Happy New Year and thank you for a great 2023!
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CMS HAS REOPENED THE NO SURPRISES ACT IDR PORTAL FOR ALL DISPUTES
On December 15, 2023, CMS reopened its IDR portal to process all dispute types and granted extensions to certain deadlines. Specifically, CMS announced: For disputing parties engaged in IDR entity selection for batched disputes when the IDR portal temporarily closed, the deadline for selecting a certified IDR entity is December 29, 2023. Disputing parties with
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PATIENTS FILE LAWSUITS AGAINST HUMANA AND UNITED’S MEDICARE ADVANTAGE PLANS FOR DENYING CARE BASED ON AI ALGORITHMS
Patients with Humana’s Medicare Advantage plan have recently filed a class action suit in federal court for the Western District of Kentucky alleging that Humana “systematically denies” medically necessary rehabilitation care based on an algorithm using artificial intelligence. The lawsuit alleges that Humana used naviHealth’s nh Predict platform to make coverage determinations for long-term rehabilitation
PATIENT GROUPS SEEK URGENT ACTION FROM CMS AND THE FTC TO ADDRESS UNITED’S ALLEGEDLY DECEPTIVE MEDICARE ADVANTAGE MARKETING
In a strongly worded letter to the Centers for Medicare & Medicaid Services and the Federal Trade Commission, four patient advocacy groups are seeking urgent action to address UnitedHealthcare’s “misleading advertising” directed at low-income Connecticut residents who are dually eligible for Medicare and Medicaid. The letter alleges that the advertisements “fraudulently induce these vulnerable individuals”
THE AHA AND FAH URGE CMS TO ENFORECE NEW MEDICARE ADVANTAGE RULES IN LIGHT OF RECENT MA PLAN POLICIES THAT AHA AND FAH BELIEVE VIOLATE THE RULES
In strongly worded letters, the American Hospital Association (AHA) and the Federation of American Hospitals (FAH) ask the Centers for Medicare & Medicaid Services (CMS) “to conduct rigorous oversight” and to enforce its new rules governing Medicare Advantage (MA) plans in light of recently adopted MA plan policies that AHA and FAH believe violate the
WASHINGTON POST ARTICLE HEADLINED “HOSPITALS AND DOCTORS ARE FED UP WITH MEDICARE ADVANTAGE” REFLECTS THE EXPERIENCE OF WHATLEY KALLAS’S PROVIDER CLIENTS
The Washington Post has published an article headlined “Hospitals and Doctors are Fed Up with Medicare Advantage,” which reports on increasing provider complaints with Medicare Advantage plans’ claim denials and onerous preapproval requirements. The article quotes Chip Kahn, the president and CEO of the Federation of American Hospitals as saying: “The insurance companies running the
NASCO ANNOUNCES DATA BREACH AFFECTING OVER 800,000 BLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS PATIENTS
Patient data has been exposed in a recently announced security breach impacting over 800,000 patients, including members of Blue Cross and Blue Shield of Massachusetts (BCBSMA). This breach included full names, email addresses, physical addresses, and telephone numbers. Social Security numbers (SSNs), health insurance and medical ID numbers, dates of service, treatment and diagnostic codes,
WELLTOK ANNOUNCES DATA BREACH AFFECTING HEALTH PLANS, INCLUDING SOME BLUE CROSS AND BLUE SHIELD PLANS
Patient data has been exposed in a recently announced security breach impacting almost 8.5 million patients, including members of several Blue Cross and Blue Shield health plans. This breach included full names, email addresses, physical addresses, and telephone numbers. For some, it also includes Social Security Numbers (SSNs), Medicare/Medicaid ID numbers, and other health insurance
THE AHA RELEASES REPORT DETAILING INCREASING FINANCIAL PRESSURES HOSPITALS FACE DUE TO RISING REIMBURSEMENT DENIALS AND DELAYS
Last Friday, the American Hospital Association released a 9-page report detailing the increasing financial pressures the nation’s hospitals are facing due to rising reimbursement denials and delays from payers, including Medicare Advantage and commercial plans. Among other things, the report — which analyzed data from 1,300 hospitals across the country — found that the median
THE AHA IDENTIFIES WHATLEY KALLAS AS A LAW FIRM WITH EXPERIENCE TO REPRESENT HOSPITALS PURSUING CLAIMS FOR 340B DRUG PAYMENTS AGAINST MEDICARE ADVANTAGE PLANS
The American Hospital Association has issued a Special Bulleting alerting its members contracted with Medicare Advantage plans that they may have claims for reimbursement for underpayments under the 340B Drug Pricing Program. The Special Bulletin advised members: To assist members in this effort, we have identified and spoken with four outside law firm that have