HIMSS sells annual conference to InformaHIMSS sells annual conference to InformaHIMSS sells annual conference to Informa

HIMSS sells annual conference to Informa

The idea to sell the organization’s flagship show had been discussed internally for “a number of years," said HIMSS CEO Hal Wolf. 

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Medicare Advantage growth boosts Humana Q2 profitsMedicare Advantage growth boosts Humana Q2 profitsMedicare Advantage growth boosts Humana Q2 profits

Medicare Advantage growth boosts Humana Q2 profits

Executives said Medicare Advantage utilization rates are beginning to stabilize in the outpatient setting.

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Prices increase at independent hospitals post-acquisition, research showsPrices increase at independent hospitals post-acquisition, research showsPrices increase at independent hospitals post-acquisition, research shows

Prices increase at independent hospitals post-acquisition, research shows

Average inpatient prices for commercially insured patients rose 5% after health systems acquired an independent hospital, according to the analysis.

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CMS sets pay hikes for inpatient, long-term care hospitalsCMS sets pay hikes for inpatient, long-term care hospitalsCMS sets pay hikes for inpatient, long-term care hospitals

CMS sets pay hikes for inpatient, long-term care hospitals

The Centers for Medicare and Medicaid Services also updated the hospital quality reporting program and outlined new health equity initiatives.

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Addus HomeCare threatens market exits over CMS rulesAddus HomeCare threatens market exits over CMS rulesAddus HomeCare threatens market exits over CMS rules

Addus HomeCare threatens market exits over CMS rules

Addus HomeCare reported $14.9 million in net income for the second quarter on Monday, a 31.9% increase from the year-ago period.

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U.S. sues UnitedHealth over 'thousands' of denied claimsU.S. sues UnitedHealth over 'thousands' of denied claimsU.S. sues UnitedHealth over 'thousands' of denied claims

U.S. sues UnitedHealth over 'thousands' of denied claims

A UnitedHealth Group unit denied thousands of emergency department and drug screening claims without reviewing them for medical necessity, the Labor Department alleges in a lawsuit initiated on Monday.

The complaint filed in the U.S. District Court for the Western District of Wisconsin targets UMR, a third-party administrator within the company's UnitedHealthcare subsidiary, and accuses it of violating the Employee Retirement Income Security Act of 1974. The Labor Department alleges UMR "simply denied" claims without assessing their merit.

UnitedHealth Group, which touts UMR as the largest third-party administrator of group health plans covering more than 5 million employees and dependents, did not immediately respond to a request for comment. The Labor Department likewise did not immediately respond to a request for comment.

The Labor Department asserts that UMR violated the Affordable Care Act’s “prudent layperson" standard by denying emergency department claims for members of 371 self-funded plans. The company “failed to consider what a person with average knowledge of health and medicine would think at the time the symptoms present themselves" and refused to pay claims that did not include specific codes indicating “True ER” or “Sudden and Severe” diagnoses, according to the lawsuit.

“UMR considers no additional information and conducts no further analysis or review of the claim before the initial denial,” the Labor Department alleges.

From August 2015 to August 2018, UMR denied all urine drug screening claims without conducting medically necessity reviews, the complaint says. UMR subsequently modified its claims review process to allow coverage of some urine drug screenings performed in emergency settings, according to the Labor Department.

In October 2019, UMR also changed its practices by demanding additional medical records from providers rather than deeming claims medically unnecessary without spelling out what kind of information it needed for appeals or why, the government alleges.

The Labor Department wants the court to order UMR to reprocess all of the claims in question, formulate new processes for reviewing emergency department and urine drug screening claims, provide and any additional relief the judge deems equitable.

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Amazon brings direct-to-consumer telehealth to all 50 states Amazon brings direct-to-consumer telehealth to all 50 states Amazon brings direct-to-consumer telehealth to all 50 states

Amazon brings direct-to-consumer telehealth to all 50 states

The direct-to-consumer telehealth service gives users access to third-party providers for non-urgent health conditions ranging from pink eye to urinary tract infections.

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Midwest hospital M&A market heats up, but faces policy hurdlesMidwest hospital M&A market heats up, but faces policy hurdlesMidwest hospital M&A market heats up, but faces policy hurdles

Midwest hospital M&A market heats up, but faces policy hurdles

Hospital M&A advisers expect more consolidation, but health systems may be limited by opposition from state officials.

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Opinion: Start at the top to address structural inequityOpinion: Start at the top to address structural inequityOpinion: Start at the top to address structural inequity

Opinion: Start at the top to address structural inequity

Providers, payers, purchasers and other organizations have plenty of opportunities to further dismantle bias, write two healthcare leaders.

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EEOC files race discrimination suit against home health agencyEEOC files race discrimination suit against home health agencyEEOC files race discrimination suit against home health agency

EEOC files race discrimination suit against home health agency

Federal authorities allege the home health agency Four Seasons broke the law by acceding to patients demanding not to be treated by Black and Hispanic employees.

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