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ArentFox Schiff

Health Insurers Sued Over Use of Artificial Intelligence to Deny Medical Claims

ArentFox Schiff on

With the surge of interest in artificial intelligence (AI), it should be no surprise that health insurers have come under scrutiny concerning their use of AI predictive tools to deny medical insurance claims. The question...more

The Volkov Law Group

Cigna Group Falls Under the False Claims Axe and Pays Over $172 Million for Abuse of Medicare Advantage Program

The Volkov Law Group on

As if corporate healthcare businesses needed an enforcement reminder, DOJ recently announced a settlement with Cigna Group for $172 million to resolve claims that Cigna exaggerated patient illnesses to extract more money from...more

ArentFox Schiff

Investigations Newsletter: SCOTUS Denies Cert In Cases Addressing FCA Pleadings Requirements

ArentFox Schiff on

SCOTUS Denies Cert In Cases Addressing FCA Pleadings Requirements - On Monday, October 17, 2022, the US Supreme Court rejected three petitions asking the Court to resolve a circuit split regarding the Rule 9(b)...more

Arnall Golden Gregory LLP

Ninth Circuit Sides With Plaintiff, Reviving $8.6M Reimbursement Suit

Arnall Golden Gregory LLP on

AGG Healthcare attorneys Matthew M. Lavin and Aaron R. Modiano recently secured a revival of an $8.6 million reimbursement suit against Cigna Health and Life Insurance. In Bristol SL Holding, Inc. v. Cigna Health and Life...more

Akerman LLP - Health Law Rx

FTC Investigating the Competitive Effects of Certificates of Public Advantage

Akerman LLP - Health Law Rx on

The Federal Trade Commission has issued orders to five health insurers and two health systems requiring them to provide information that will assist the FTC in studying the competitive effects of certificates of public...more

Sheppard Mullin Richter & Hampton LLP

Health Plans and Pharmacy Benefit Managers – Past and Future

Sheppard Mullin Richter & Hampton LLP on

Historically, health plans and pharmacy benefit managers (“PBMs”) have been uncomfortable neighbors. Plans provide drug coverage, but contract out the provision of such drugs to independent PBMs. PBMs in turn earn market...more

Polsinelli

Mega-Mergers Highlight Risk to Health Care Providers

Polsinelli on

Consolidation in health insurance markets can injure hospitals and doctors by creating buyer-side market power that can force providers to accept below-market prices, limit patients’ access to care, and reduce innovation in...more

Foley & Lardner LLP

Payers Embracing Telemedicine Cost Savings, Ramping Up Reimbursement in 2016

Foley & Lardner LLP on

Often considered the primary obstacle to telemedicine implementation, reimbursement changes are now better viewed as one of the most prominent drivers of telemedicine expansion. Payers are finally beginning to realize what...more

Brownstein Hyatt Farber Schreck

The Reformed Health Care Industry: Creative Structures and Alliances Can Yield Great Benefits, but Also Great Risks

Brownstein Hyatt Farber Schreck on

Since the Affordable Care Act (the “ACA”) was enacted in 2010, the health care industry has been on the edge of its proverbial seat waiting to see which care delivery models are best suited to sustain all the changes: to...more

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