CalAIM is an initiative of the California Department of Health Care Services (the Department) to improve the quality of life and health outcomes of Medi-Cal members by implementing delivery system, program, and payment...more
6/12/2025
/ California ,
Community Service ,
Health Insurance ,
Healthcare ,
Healthcare Costs ,
Healthcare Reform ,
Long-Term Care ,
Managed Care Contracts ,
Medi-Cal ,
Medicaid ,
Public Health ,
State Health Departments ,
Telehealth
Nurses make up the largest section of the healthcare profession and spend more time with patients than any other care team member. During the COVID-19 pandemic, many people learned the incredible impact hospital nurses have...more
This article highlights legal disputes central to APRNs’ ability to practice independently, the use of professional titles, insurance discrimination, and broader healthcare competition dynamics. Around the country, Advanced...more
ERISA Health Plan clients are engaged in nearly every industry in the United States. There are nearly 139 million Americans covered by ERISA Health Plans and 2.5 million Health Plans. Yet, operating a health plan has become...more
2/19/2025
/ Artificial Intelligence ,
Compliance ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Enforcement Actions ,
Health Insurance ,
Healthcare Fraud ,
Insurance Claims ,
Insurance Litigation ,
No Surprises Act (NSA) ,
Risk Management
In the wake of the December 4, 2024 fatal shooting of UnitedHealthcare’s CEO Brian Thompson, questions were raised about insurance claim denial practices. Several news outlets noted that UnitedHealth Group’s profits have been...more
1/31/2025
/ Antitrust Division ,
Artificial Intelligence ,
Claims Processing Systems ,
Competition ,
Denial of Insurance Coverage ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Employee Retirement Income Security Act (ERISA) ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Insurance Claims ,
Insurance Industry ,
Medicare ,
Pharmacy Benefit Manager (PBM) ,
Provider Payments ,
Quality of Care Standards ,
Regulation ,
Regulatory Reform ,
United Healthcare Insurance Co.
The California Department of Public Health’s (CDPH) September 6, 2024, All Facilities Letter (AFL) reaffirms the independent practice authority of Certified Registered Nurse Anesthetists (CRNAs). Despite this reaffirmation,...more
12/9/2024
/ Acute Facilities ,
California ,
CDPH ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Facilities ,
Hospitals ,
Medical Reimbursement ,
Nurses ,
Scope of Work