News & Analysis as of

Payers Embracing Telemedicine Cost Savings, Ramping Up Reimbursement in 2016

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

Congress Takes Long Look at Proposed Health Insurance Mergers

While the Department of Justice Antitrust Division is responsible for reviewing the proposed Anthem/Cigna and Aetna/Humana mergers for any potential competitive concerns, Congress jumped into the process with both feet in...more

Health Care Mergers Come Under Scrutiny

In July, 2015, Aetna struck a deal to buy Humana for $37 billion, which would cover 33 million members. Merging with Humana would give Aetna more than one-quarter of the total Medicare Advantage market, analysts say. In...more

Send Lawyers, Guns and Money:* Providers Lining Up Against Anthem/Cigna and Aetna/Humana Mergers

In the wake of Anthem’s proposed acquisition of Cigna and Aetna’s proposed acquisition of Humana, providers are lining up to be heard. Take the American Medical Association (AMA), for example, which is urging federal and...more

Health Insurers Announce Merger Plans; Congress Announces Intention to Review

In the last few months, several of the largest commercial health insurers in the nation have announced their intentions to merge. First, Aetna (currently the nation’s third largest health insurer by revenue) announced its...more

Regulators Likely To Heavily Scrutinize Proposed Humana-Aetna Merger

At the beginning of the month, insurance companies Aetna Inc. and Humana Inc. announced they would be pursuing a merger, with the former company acquiring the latter. Aetna, sources say, will be purchasing Humana for roughly...more

Aetna to Acquire Humana for $37 Billion

According to data supplied by the companies (pdf), Aetna is the larger of the companies, with 23.67 million medical members to Humana’s 9.77 million. Aetna also has a larger dental insurance business, with 15.56 million...more

All About That Base: Claim Against Fat Loss Supplement Maker Fails For Lack of Ascertainability

Adam Karhu bought a dietary supplement called VPX Meltdown Fat Incinerator (“Meltdown”) in reliance on advertising by Vital Pharmaceuticals, Inc. (“VPX”) that Meltdown would result in fat loss. Concerned that Meltdown did not...more

Will Increased Consolidation in the Insurance Industry Yield Opportunities or Challenges for Investors?

A recent flurry of activity in the health insurance industry would seem to indicate that investors can expect significant consolidation in the managed care sector....more

Eleventh Circuit Affirms Dismissal of Relator's Complaint Under Amended Public Disclosure Bar

In United States of America ex rel. Marc Osheroff v. Humana, Inc. et al., No. 13-15278 (11th Cir., Jan. 16, 2015), the Eleventh Circuit affirmed dismissal of a relator’s complaint under the public disclosure bar of the False...more

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

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

Lawsuit Against Medtronic Alleges Racketeering Over Infuse Bone Graft

When one big industry sues another we learn a lot about how business as usual is conducted. In this case Humana, a giant health insurer, has sued the medical device company Medtronic, maker of the Infuse bone graft. ...more

The Precedential Value of Seriatim Wisconsin Court of Appeals Opinions

In April we wrote about the Wisconsin Court of Appeals opinions compelling State Senator Jon Erpenbach to produce non-redacted emails under Wisconsin’s Public Records law. Today, the Court of Appeals ordered that the opinions...more

Policyholders Face Heightened Scrutiny Under OCR’s New Permanent Audit Program

The U.S. Department of Health and Human Services’ Office for Civil Rights (“OCR”) has notably increased enforcement of compliance with the Health Insurance Portability and Accountability Act (“HIPAA”) and Health Information...more

ARB Issues Reconsideration Decision in OFCCP v. Florida Hospital of Orlando

On July 22, 2013, the Administrative Review Board (ARB) of the Department of Labor (DOL) held that a network participation agreement entered into by Florida Hospital with Humana Military Health Services (HMHS) for the...more

Supreme Court Denies Certiorari in MAO’s Double Damages Case

On April 15, 2013, the United States Supreme Court denied a petition for certiorari brought by GlaxoSmithKline (“Glaxo”) seeking review of a Third Circuit decision in favor of Humana Medical Plan (“Humana”), as a Medicare...more

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