News & Analysis as of

Health Insurance Fraud Insurance Industry

Davis Wright Tremaine LLP

Anthem's New Chargemaster-Based Claim Edits: Which Charges and Providers Will Anthem's New Process Target and How Will It Impact...

Effective August 1, 2025, Anthem will implement a new claims-editing process that adjusts payments for Medicare Advantage (MA) claims based on an undisclosed, customized chargemaster table. The announcement identifies claims...more

Stevens & Lee

New Changes to Medicare and Private Prior Authorization Processes

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Both the Centers for Medicare & Medicaid Services (CMS) and dozens of the nation’s largest insurance companies have revealed upcoming changes to their prior authorization processes. These changes aim to reduce the prevalence...more

Rivkin Radler LLP

FBI Warns Consumers of Discount Medical Scams

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On April 30, the Federal Bureau of Investigation (FBI) released a Public Service Announcement warning consumers about fraudulent discount medical scams. These scams typically involve deceptive offers for health insurance...more

Ropes & Gray LLP

Key Trends in Dual-Eligible Health Insurance: Takeaways from the Medicarians Conference

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Attorneys from Ropes & Gray attended the Medicarians Conference from March 31 to April 2, a premier event for Medicare Advantage (MA) and other health insurance brokers, agents, and distribution arms, as well as regional and...more

Goodwin

Aetna’s “Fraud Scheme” Lawsuit Against Radiology Group Highlights Health Plans’ Resistance to Private-Equity-Backed Providers

Goodwin on

On December 23, 2024, various Aetna affiliates (referred to hereafter as Aetna) filed suit against Radiology Partners, Inc., a national, private-equity-backed radiology group, alleging that Radiology Partners defrauded the...more

McAfee & Taft

Gavel to Gavel: Justice Department takes aim at private health plan fraud

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Historically, the U.S. Department of Justice has directed its efforts on combatting healthcare fraud by focusing on persons and companies who defraud or attempt to defraud federally funded healthcare programs, such as...more

Mitchell, Williams, Selig, Gates & Woodyard,...

National Association of Insurance Commissioners (NAIC) Fall 2024 Meeting Summary

The Mitchell Williams Insurance Regulatory team of attorneys recently attended the National Association of Insurance Commissioners (NAIC) Fall 2024 National Meeting which was held in Denver, Colorado. We have prepared a...more

Mitchell, Williams, Selig, Gates & Woodyard,...

National Association of Insurance Commissioners (NAIC) 2023 Summer Meeting Summary

The Mitchell Williams Insurance Regulatory team of lawyers recently attended the National Association of Insurance Commissioners (NAIC) 2023 Summer National Meeting which was held in Seattle, Washington. We have prepared a...more

Patrick Malone & Associates P.C. | DC Injury...

Insurers buck-raking big time off Medicare Advantage

​​​​​​​The nation’s biggest health insurers are gaming a giant program to provide health coverage to seniors, exploiting the privatization of Medicare Advantage plans to rake in profits with schemes that have drawn fire from...more

Hendershot Cowart P.C.

My Practice Received a Letter from an Insurance Company SIU – What Should I Do?

Hendershot Cowart P.C. on

SIU stands for Special Investigation Unit, and nearly all insurance companies have one, especially health insurers. SIUs exist to investigate complaints of fraud, waste or abuse, and train claims personnel to recognize and...more

Bradley Arant Boult Cummings LLP

The Uncertain Legal Intersection of Genetic Tests and Life Insurance

The growth of direct-to-consumer DNA kits is a big deal with significant ramifications for the life insurance industry. Direct-to-consumer DNA kits, commonly used to track ancestry roots, increasingly allow individuals to...more

Robins Kaplan LLP

Your Daily Dose of Financial News

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We’ve talked a fair amount about the switch to chip & pin card systems over the past few years. But how about a lack of cards altogether? Because that’s what the banks have in mind....more

Holland & Knight LLP

Religious Institutions Update: August 2016

Holland & Knight LLP on

When was the last time your organization reviewed your insurance policies? Not all policies are equal. Many religious organizations are underinsured. Most should have general liability, property, professional liability,...more

Carlton Fields

Phishing for Cybersecurity Coverage: When is a Fraud a “Computer Fraud”?

Carlton Fields on

In late June, the New York Court of Appeals affirmed a trial court ruling that there was no coverage for a health insurance company policyholder, under a “Computer Systems Fraud” rider issued by its insurer, for an underlying...more

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