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The Federal Trade Commission has announced that it is withdrawing two antitrust policy statements related to enforcement in healthcare markets.  The withdrawn policy statements are: Statements of Antitrust Enforcement Policy in Health Care (August 1, 1996)  Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program (October 20, 2011) …

FTC WITHDRAWS TWO ANTITRUST POLICY STATEMENTS RELATED TO HEALTHCARE Read More »

Former U.S. District Judge U.W. Clemon writes at AL.com that the Supreme Court must be expanded to preserve opportunity for disadvantaged groups. Judge Clemon, a good friend of Whatley Kallas and our frequent co-counsel, movingly describes his own experience: the University of Alabama barred its doors to him as an undergraduate and a law student …

JUDGE U.W. CLEMON ADVOCATES FOR SUPREME COURT EXPANSION Read More »

Following strong profits in 2022 and in the first quarter of 2023, UnitedHealth Group (“United”) again reported strong profits for the second quarter of 2023, with double-digit revenue growth at both UnitedHealth and Optum.  United’s second quarter results once again beat analysts’ expectations. In a press release, United stated “strong and well-balanced growth continued across …

UNITEDHEALTH GROUP REPORTS STRONG PROFITS FOR THE SECOND QUARTER OF 2023, BEATING ANALYSTS’ EXPECTATIONS Read More »

In its July 2023 issue, linked here, Florida Trend recognizes Aaron Podhurst, of Podhurst Orseck, as a Legal Lion.  The 8-page profile of Aaron tells the story of Aaron’s life and dedication to the practice of law.  From growing up in the Catskills of New York, to representing victims of air disasters, healthcare providers against …

WHATLEY KALLAS CONGRATULATES AARON PODHURST ON BEING RECOGNIZED AS A LEGAL LION BY FLORIDA TREND Read More »

A settlement has been reached in a lawsuit affecting consumers enrolled in two California state-sponsored health care programs for individuals living with HIV.  Notice of the Settlement was mailed on June 16, 2023. The settlement addresses an alleged unauthorized disclosure of protected health information, including HIV status, by certain defendants as part of the California Department of …

JOHN DOE v. CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, et al., Los Angeles Superior Court, Case No. 20STCV3236 Read More »

Cigna has announced a delay in implementing a policy that would have required physicians to submit clinical documentation whenever they submit a claim with certain Evaluation and Management (“E/M”) CPT® codes appended with a modifier 25. Modifier 25 is used to indicate that a patient’s condition requires a significant, separately identifiable E/M service on the …

FACING STRONG OPPOSITION FROM PHYSICIAN GROUPS, CIGNA POSTPONES IMPLEMENTATION OF MODIFIER 25 POLICY Read More »

UnitedHealthcare had been preparing to implement a policy beginning on June 1, 2023 that would have required prior authorization for most GI endoscopic procedures, including colonoscopies.  The policy was strongly opposed by provider groups including the American Hospital Association, the American Gastroenterological Association, the American College of Gastroenterology, the American Society for Gastrointestinal Endoscopy, and …

FACING STRONG OPPOSITION FROM PROVIDER GROUPS, UNITED RESCINDS ITS POLICY REQUIRING PRIOR AUTHORIZATION FOR GI PROCEDURES REPLACING IT WITH A PRIOR NOTIFICATION POLICY Read More »

Highmark Health has reported first quarter 2023 revenues of $6.7 billion, an increase of 4.6% from the prior year quarter.  This increase follows strong revenue growth of 18% in 2022, with total 2022 revenues of $26 billion.  Highmark also reported net income of $227 million for the first quarter. In a press release announcing its …

HIGHMARK REPORTS STRONG REVENUE GROWTH FOR 2022 AND THE FIRST QUARTER OF 2023 Read More »

Kaiser Family Foundation Health News (“KFF”) has published a news perspective entitled “Denials of Health Insurance Claims are Rising – and Getting Weirder” that shows a sharp increase in denials of health insurance claims. A recent KFF study of Affordable Care Act (“ACA”) plans found that health insurance companies denied an average of 17% of …

KAISER FAMILY FOUNDATION HEALTH NEWS PERSPECTIVE: “DENIALS OF HEALTH INSURANCE CLAIMS ARE RISING – AND GETTING WEIRDER” Read More »

An American Hospital Association post highlighted findings from a Crowe Research report (“the Report”) showing that one in three inpatient claims submitted by providers to commercial insurers was not paid for over three months and that 15% of inpatient and outpatient claims were initially denied.  The AHA post also highlighted the Report’s findings that: claims …

AHA HIGHLIGHTS REPORT SHOWING THAT HOSPITALS STRUGGLE TO COLLECT PAYMENTS FROM COMMERCIAL INSURERS Read More »