News & Analysis as of

Health Insurance United Healthcare Insurance Co.

Ogletree, Deakins, Nash, Smoak & Stewart,...

The Ninth Circuit Speaks Out on Mental Health Parity

On April 11, 2024, the U.S. Court of Appeals for the Ninth Circuit, in Ryan S. v. UnitedHealth Group, Inc., set a very broad pleading standard to allege a violation of the Paul Wellstone and Pete Domenici Mental Health Parity...more

WilmerHale

The Interplay: Key Decisions at the Intersection of Antitrust & Life Sciences - January 2024

WilmerHale on

Illumina Agrees to Unwind Acquisition of Grail Following Fifth Circuit Decision.  On December 15, 2023, the Fifth Circuit vacated the FTC’s order that Illumina unwind its acquisition of Grail—a developer of a multi-cancer...more

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

Manatt, Phelps & Phillips, LLP

Court Rules Provider’s Prior Authorization Calls with Payor Not a Binding Contract

In a decision important to health care payors and providers alike, a California Court of Appeal, in AToN Center, Inc. v. United Healthcare Insurance Company, et al., 93 Cal.App.5th 1214 (2023), agreed with a lower court...more

Cozen O'Connor

UnitedHealthcare’s Changing Approach to Prior Authorizations

Cozen O'Connor on

Prior authorizations, one of health insurers’ many “utilization management” techniques, is a hot topic amongst practicing physicians, patients, and regulators, to name a few. The prior-authorization process requires a health...more

Akerman LLP - Health Law Rx

FTC Investigating the Competitive Effects of Certificates of Public Advantage

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

King & Spalding

Turning the Screw: United Deploying New Site of Service Policy for Musculoskeletal Surgeries

King & Spalding on

Payers are increasingly establishing purported “site of service” policies and guidelines that restrict the circumstances under which members may obtain certain services at hospital outpatient departments (HOPDs). In the...more

The Volkov Law Group

Double Whammy for United Healthcare: Two False Claims Act Cases in Two Weeks

The Volkov Law Group on

The False Claims Act is the government’s weapon of choice in fighting healthcare fraud. In the beginning of the Obama Administration, Congress amended the False Claims Act and enacted a wish list from DOJ prosecutors. ...more

Hinshaw & Culbertson LLP

SCOTUS Declines Review in Case Allowing Health Care Provider to Pursue State Law Misrepresentation Claims Against ERISA Health...

The United States Supreme Court recently denied certiorari in a Fifth Circuit case, United Healthcare Insurance Co. v. Access Mediquip LLC, that allowed a health care provider to pursue state law misrepresentation claims...more

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