News & Analysis as of

Healthcare › Provider Payments › Health Insurance

Fennemore

Regulatory Landscape of Insurance Claims Denial Practices and Suggestions for a Path Forward to a Sustainable Healthcare Future

Fennemore on

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

Bass, Berry & Sims PLC

OIG Issues Special Fraud Alert on Medicare Advantage Marketing Arrangements

Bass, Berry & Sims PLC on

On December 11, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a Special Fraud Alert (SFA) on what it refers to as “suspect” marketing schemes involving “questionable payments and...more

Ropes & Gray LLP

OIG Issues Special Fraud Alert on Medicare Advantage Marketing Arrangements

Ropes & Gray LLP on

On the heels of recent scrutiny of health care professional (“HCP”) arrangements with brokers and agents and Medicare Advantage Organization (“MAO”) arrangements with providers, including through the U.S. Department of...more

King & Spalding

OIG Issues Report Finding that Medicare Advantage Insurers Received Billions for Diagnoses Reported Only on Health Risk...

King & Spalding on

A recent OIG report found that diagnoses reported in 2022 Medicare Advantage (MA) encounter data based only on health risk assessments (HRA) and HRA-linked chart reviews resulted in CMS making additional risk-adjusted...more

Nelson Mullins Riley & Scarborough LLP

Proposed Rule Season

Nelson Mullins Riley & Scarborough LLP on

The Centers for Medicare & Medicaid Services (CMS) have released the proposed updates to the Medicare payment policies and rates for skilled nursing facilities (SNFs) for 2024. While the ruling is not final, “CMS estimates...more

Nelson Mullins Riley & Scarborough LLP

HHS Finalizes Payment Rates and Policies for the 2024 Medicare Advantage Program

Nelson Mullins Riley & Scarborough LLP on

On March 31, 2023, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced the finalized capitation rates and payment policies for the 2024 Medicare...more

Arnall Golden Gregory LLP

Takeaways From AHLA’s Institute on Medicare and Medicaid Payment Issues

Arnall Golden Gregory LLP on

AGG Healthcare attorneys Lanchi Bombalier and Charmaine Mech recently attended the American Health Law Association (AHLA)’s Institute on Medicare and Medicaid Payment Issues in Baltimore, Maryland, from March 23-25, 2022. The...more

King & Spalding

Recent Health Plan Practices That Are Resulting in Underpayments to Providers

King & Spalding on

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

Sheppard Mullin Richter & Hampton LLP

‘Twas the Season to Contract? A Year-End Review of Network Negotiations and Billing Disputes

Sheppard Mullin Richter & Hampton LLP on

As 2017 drew to a close, some health plans and healthcare providers across the country were still busy trying to finalize contracts for in-network services for 2018 and beyond. A number of negotiations made the headlines in...more

Burr & Forman

2016 Health Care Year in Review

Burr & Forman on

Since I began writing this year-end review in 2013, there have been some common themes – a shift to pay for quality and away from fee-for service, much of which has been brought about by the Affordable Care Act (ACA): efforts...more

10 Results
 / 
View per page
Page: of 1

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up Log in
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
- hide
- hide