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Medicare › Denial of Insurance Coverage

Arnall Golden Gregory LLP

UnitedHealthcare Must Face State Law Claims in Class Action Suit for AI Driven Coverage Denials of Medicare Advantage Claims

Arnall Golden Gregory LLP on

Daytime television inundates American seniors with advertisements for UnitedHealthcare’s (“UHC”) Medicare Advantage Plans. On its website, UHC claims its Medicare Advantage Plans “stand out from the rest,” providing...more

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

Oberheiden P.C.

What Does it Take to Win Medicare Appeals in 2024?

Oberheiden P.C. on

Lots of health care service providers find themselves in the position of needing to file a Medicare appeal. Despite the systematic nature of modern Medicare billing, wrongful denials remain common, and errors during Medicare...more

Whiteford

New CMS Guidance on Use of Algorithms and AI in Prior Authorizations and Utilization Management

Whiteford on

Use of algorithms and artificial intelligence (AI) in prior authorization and utilization management is facing growing criticism and litigation. Notable lawsuits include alleged automatic authorization denials for tests that...more

Arnall Golden Gregory LLP

Preemption and Exhaustion Requirements Thwart Medicare Advantage Plan Members’ Ability to Hold Health Insurers Accountable

Arnall Golden Gregory LLP on

Most states have statutes or common law that allow an insurance policyholder to bring a civil action and seek more than just compensatory damages (e.g., punitive damages) when her insurance company denies coverage in bad...more

Carlton Fields

7th Cir. Holds Insurance Coverage Applies to Settlement Payments for Alleged Anti-Kickback and False Claims Act Violations

Carlton Fields on

On May 3, 2023, the Seventh Circuit Court of Appeals, in Astellas US Holding Inc. v. Federal Insurance Co., held that a liability insurer was required to contribute its limits toward its insured’s payment to settle potential...more

King & Spalding

Federal Court Affirms Denial of Medicare Payment for Inpatient On-Call Services to Critical Access Hospital

King & Spalding on

On March 31, 2021, Judge Carl Nichols of the United Stated District Court for the District of Columbia issued a decision upholding CMS’s denial of reimbursement to a California Critical Access Hospital (CAH) for compensation...more

Health Care Compliance Association (HCCA)

Telehealth Risks Come into Focus; Some Payers Don't Cover Audio-Only

Health Care Compliance Association (HCCA) on

Report on Medicare Compliance 30, no. 8 (March 1, 2021) - After the 2021 Medicare Physician Fee Schedule extended coverage of many telehealth services until the end of the public health emergency (PHE), including...more

Bradley Arant Boult Cummings LLP

$25.5 Million Oklahoma Verdict: Jackpot Justice or Case Study on Bad Faith Litigation?

Bradley Arant Boult Cummings LLP on

We all know how prevalent bad faith claims are. It seems like almost every case involving disputed policy benefits includes one. Many have no merit and should be disposed of on summary judgment. The rest, however, arguably...more

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