There has been a flurry of recent activity in a case originally filed by six air ambulance companies claiming $20 million in unpaid emergency services invoices. ...more
Patients who expect their health insurer will work in their interests to contain costs by medical providers might just as well hope for assistance from leprechauns, unicorns, or the tooth fairy....more
The District of Columbia federal court recently ruled that a proposed $37 billion merger between health insurance giants Aetna and Humana cannot proceed, granting the US Department of Justice’s bid to block the combination on...more
Judge John Bates of the US District Court for DC has blocked a proposed $37 billion mega-health-care-merger between Aetna and Humana, one of 2 major deals before the courts opposed by the Obama-era DOJ over antitrust...more
Consolidation in health insurance markets can injure hospitals and doctors by creating buyer-side market power that can force providers to accept below-market prices, limit patients’ access to care, and reduce innovation in...more
Aetna is now facing another set of claims calling into question its determination and payment methodology for out-of-network reimbursement. On September 4, 2015, six surgical centers in Texas (Allied Center for Special...more
Healthcare providers virtually always rely upon assignment of benefits agreements executed by patients as a basis for reimbursement from health insurers. When those insurers fail to reimburse the provider altogether, or fail...more
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
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
On February 23, 2015, Aetna filed suit in Texas federal court against Robert A. Behar, M.D. and North Cypress Medical Center (North Cypress), alleging that Dr. Behar, the CEO of North Cypress, offered impermissible ownership...more
A New York City Tax Appeals Tribunal Administrative Law Judge (ALJ) recently ruled in favor of Aetna, Inc. (Aetna) on whether a health maintenance organization (HMO) was “doing an insurance business” in New York State,...more