ADA, and other organizations move to boost workforce development, training for dental hygienists - In addition to several legislative moves aimed at boosting the training and development of dental hygienists, dental...more
On Feb. 21, 2024, the ransomware hacker group ALPHV, otherwise known as "BlackCat," disabled Change Healthcare's nationwide healthcare billing and information systems and demanded a ransom to unlock them....more
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
The U.S. Department of Labor (“DOL”) recently filed a lawsuit against UMR, Inc., a third-party administrator and UnitedHealth Group, Inc. subsidiary. The lawsuit alleges that UMR denied thousands of claims based on diagnosis...more
Earlier this year, Assistant Attorney General Jonathan Kanter, who leads the Department of Justice’s (DOJ) Antitrust Division, announced that the Antitrust Division would eschew settlements in merger challenges in...more
On June 21, 2022, the Supreme Court denied certiorari in the case of UnitedHealthcare Co., et al v. Becerra et al., Case No. 21-1140, wherein UnitedHealthcare attempted to overturn the D.C. Circuit Court’s revival of CMS’s...more
New York AG Letitia James and the S. Department of Labor (“DoL”) reached a settlement with health insurer UnitedHealth Group Inc. and related entities (collectively “UHG”) to resolve allegations that it wrongfully reduced or...more
In April 2020, the Department of Health and Human Services (HHS) revealed a plan to disperse $175 billion in funding for health care providers allocated by the Coronavirus Aid, Relief, and Economic Security (CARES) Act and...more
UnitedHealthCare ("United") is instituting a new policy imposing a “Requirement to Use a Specialty Pharmacy Provider for Certain Medications” (“Specialty Pharmacy Policy”) that is scheduled to take effect on April 1, 2020. ...more
In its decision, the Court concluded that UnitedHealth Group, Inc. (“United”) was not authorized to engage in “cross-plan offsetting.” What is cross-plan offsetting? It is a “self-help” practice that third party...more
The Medicare Advantage program, which allows private insurance companies to offer and administer Medicare benefits, continues to be an area of sharp scrutiny for False Claims Act (FCA) enforcement despite some significant...more
Health Plans’ Use of Policies and Guidelines to Reduce Coverage and Reimbursement - A technique we have seen payers use more commonly in recent months than in the past is to unilaterally implement policies or “clinical...more
On October 5, a federal district court in California dealt a significant setback to the government’s efforts to extend False Claims Act (FCA) liability to Medicare risk adjustment submissions....more
On October 5, 2017, the Honorable Judge John Walter of the United States District Court, Central District of California, granted the Defendants’ Motion to Dismiss the Medicare Advantage (“MA”) Federal False Claims Act (“FCA”)...more
As reported in earlier blogs, the federal Department of Justice (DOJ) has been actively looking into potential abuses by Medicare Advantage (MA) Organizations as to allegedly improper risk adjustment claims submissions and...more
Recently, the DOJ intervened in one of several currently pending qui tam cases involving Medicare Advantage (MA) and the Risk Adjustment process used to determine the amount of payments to Medicare Advantage Organizations...more
In early January, the New York Attorney General's Office announced that it had reached an agreement with UnitedHealth that would conclude the AG Office's investigation into UnitedHealth's marketing of elder care and nursing...more
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
Last month the Second Circuit Court of Appeals reversed the U.S. District Court’s decision to deny the New York State Psychiatric Association (NYSPA) standing in its claim against UnitedHealth Group and related entities...more
In late August the U.S. Court of Appeals for the Second Circuit reinstated a lawsuit by a physician association against a third-party plan administrator. The case against UnitedHealth Group and related entities (United) had...more
In suing the California Insurance Commissioner on July 10, 2014, PacifiCare Life Insurance Company sought a writ of mandamus ordering the Commissioner to set aside his Decision and Order imposing a record $173 million penalty...more
A few weeks ago several large institutional investors identified as the Shareholder-Director Exchange (SDX) Working Group sent a letter to the lead directors and corporate secretaries of Russell 1000 companies asking them to...more