Cigna plans rate hikes amid high ACA risk-adjustment chargesCigna plans rate hikes amid high ACA risk-adjustment chargesCigna plans rate hikes amid high ACA risk-adjustment charges

Cigna plans rate hikes amid high ACA risk-adjustment charges

Cigna's net income declined 6.2% to $1.5 billion in the second quarter, the health insurance company reported Thursday.

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Q&A with VillageMD on Stay Well Care Plans initiativeQ&A with VillageMD on Stay Well Care Plans initiativeQ&A with VillageMD on Stay Well Care Plans initiative

Q&A with VillageMD on Stay Well Care Plans initiative

"This is concierge care for a senior patient without a concierge fee," VillageMD Chief Medical Officer Dr. Stuart Levine said of the company's Stay Well Care Plans offering.

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Amwell sees revenue decline, subscriber churnAmwell sees revenue decline, subscriber churnAmwell sees revenue decline, subscriber churn

Amwell sees revenue decline, subscriber churn

 Part of Amwell's net losses were attributed to a $27.3 million non-cash goodwill impairment charge recorded in the second quarter. 

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Community Health Systems still vying for profitability in Q2Community Health Systems still vying for profitability in Q2Community Health Systems still vying for profitability in Q2

Community Health Systems still vying for profitability in Q2

For-profit Community Health Systems reported a net loss of $38 million, or 29 cents per diluted share, in the second quarter.

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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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