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Becker’s Healthcare has published an article headlined “Hospitals are dropping Medicare Advantage left and right” due to denials and late payments. As the president and CEO of Scripps Health, Chris Van Gorder, stated in the article: “It’s become a game of delay, deny and not pay.” The article also cites the example of the St. […]

The Departments of Health and Human Services, Labor and the Treasury (“the Departments”) have issued proposed rules governing the establishment of fees for the Independent Dispute Resolution (“IDR”) process under the No Surprises Act.  The new rules were necessitated after a federal court struck down the previous increased fee of $350, which had been challenged

After a highly profitable 2022, the nation’s health insurers continue to reap strong profits in 2023.  The major health insurers have all reported on their second quarter earnings and they all reported strong earnings. Of the nation’s largest health insurers, UnitedHealth Group posted the highest profits for the second quarter 2023 with $5.5 billion in

The Kaiser Family Foundation has reported that the federal government is poised to pay Medicare Advantage plans at least $12.8 billion in quality bonus payments this year, an increase of 30% over 2022.  Annual bonus payments to Medicare Advantage plans have increased every year since 2015. According to the report, UnitedHealthcare will receive $3.9 billion,

For the third time, United States District Court Judge Jeremy D. Kernodle of the Eastern District of Texas has struck down certain rules implementing the arbitration process under the No Surprises Act (“the Act”) after a challenge by the Texas Medical Association (“the TMA”). Specifically, the Court struck down CMS guidance increasing the fee for

In its 2023 legislative session, the Colorado General Assembly repealed the state’s previous antitrust law and enacted the Colorado State Antitrust Law of 2023, which has now been signed into law by Governor Jay Polis. The new law provides: Allows any person injured, directly or indirectly, by an antitrust violation to seek an injunction Allows

The Mount Sinai Medical Legal Partnership (“MSMLP”) has opened a legal clinic for Mount Sinai Health System breast cancer patients needing legal assistance to navigate issues arising from their diagnoses, including issues relating to unemployment, housing, social security benefits and end-of-life documents. In a press release, MSMLP’s Executive Director Allison Charney stated: “We want all

The United States Department of Labor has sued UMR, Inc., which serves as a third party administrator for UnitedHealth ERISA-covered plans, for improperly denying claims for emergency department services and for urinary drug screening.  UMR’s parent company is UnitedHealth Group, Inc.  The complaint was filed in the United States District Court for the Western District

The United States Departments of Labor, Health and Human Services, and the Treasury have proposed rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (“the Act”) designed to ensure that health insurance plans comply with the Act’s requirements to provide benefits for mental health and substance use

Elevance Health, Inc. (formerly known as Anthem) reported strong Second quarter 2023 profits with double-digit growth in profits and operating revenue.  Elevance reported profits of $1.9 billion, an increase of 13.2% over the prior year quarter’s profits. Elevance’s second quarter revenues were also sharply up, growing 13% over the prior year quarter to $43.7 billion.