Jacqueline Glennon

Cozen O'Connor

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Latest Posts › Medicare Advantage

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Justice Department Continues Pattern of False Claims Act Suits Due to Alleged Kickbacks

On May 1, the federal government brought a False Claims Act (“FCA”) suit against three health insurers, as well as three insurance brokers. The Justice Department’s suit alleges that the insurers paid millions of dollars in...more

5/14/2025 / Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , Department of Justice (DOJ) , Enforcement Actions , False Claims Act (FCA) , Healthcare Fraud , Insurance Industry , Medicare , Medicare Advantage , OIG

CMS Issues Final Rule Impacting Prior Authorization Process

Last week CMS issued its final rule “CMS Interoperability and Prior Authorization” (CMS-0057-F), unchanged from its proposed rule in 2022, which addresses prior authorizations. Prior authorization, a “utilization management”...more

1/24/2024 / Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Final Rules , Medicaid , Medicare , Medicare Advantage , MIPS , Physicians , Prior Authorization , Provider Payments

UnitedHealthcare’s Changing Approach to Prior Authorizations

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

7/14/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Health Insurance , Medicare Advantage , Physicians , Prior Authorization , United Healthcare Insurance Co.

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