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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.

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!

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

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