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Artificial Intelligence Medicare Advantage

Furia Rubel Communications, Inc.

Navigating the Regulatory Complexities of an Evolving Health Care System with Kathleen Fisher Enyeart, Counsel at Lathrop GPM

In this episode of On Record PR, Gina Rubel goes on record with Kathleen Fisher Enyeart, Counsel at Lathrop GPM, to discuss the challenges of complying with health care regulations in a complex and rapidly changing industry....more

Eversheds Sutherland (US) LLP

AI Litigation Insights - Barrows et al. v. Humana, Inc.

Health insurer Humana was sued in a class action challenging the process by which it made claim determinations and alleging that it knowingly used a “highly inaccurate” artificial intelligence model, nH Predict, to improperly...more

Health Care Compliance Association (HCCA)

CMS issues additional guidance to clarify new MA regulations

On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) published an expansive final rule amending Medicare Advantage (MA) regulations related to, among other things, coverage criteria and prior authorization....more

McDermott Will & Emery

CMS Issues Guidance on Usage of AI in Making Coverage Determinations

McDermott Will & Emery on

On February 6, 2024, the US Centers for Medicare & Medicaid Services (CMS) issued a letter to all Medicare Advantage (MA) organizations and Medicare-Medicaid plans. The letter covered frequently asked questions and answers...more

Venable LLP

Navigating the Future: Medicare Advantage Plan Rules on the Use of Artificial Intelligence

Venable LLP on

The use of technology in healthcare services and payment for healthcare is evolving at an unprecedented pace, reshaping how medical services are delivered, managed, and paid for. The use of artificial intelligence systems...more

McDermott+

President Biden Releases FY 2025 Budget: What’s NOT in It?

McDermott+ on

Earlier this week, President Biden released his Fiscal Year (FY) 2025 President’s Budget. As a reminder, every year, the White House releases a budget that serves as its official funding request to Congress for the following...more

Holland & Knight LLP

Holland & Knight Health Dose: March 5, 2024

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Holland & Knight Health Dose is an in-depth weekly dose of legislative and regulatory insights to keep stakeholders abreast of happenings in Washington, D.C., impacting the health sector. ...more

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

Better Health Care Newsletter - March 2024

Is Medicare Advantage really a Disadvantage for seniors and taxpayers? Our nation is graying rapidly. Every day, 10,000 baby boomers, members of one of the largest generations in U.S. history, hit the traditional...more

Holland & Knight LLP

Key Value-Based Care Developments to Watch in 2024

Holland & Knight LLP on

The goal of value-based care (VBC) is to promote better care for individual patients and improved health outcomes for communities at reduced costs. This is an important and admirable purpose as many VBC stakeholders attempt...more

American Conference Institute (ACI)

[Event] 15th Annual Advanced Forum on Managed Care Disputes and Litigation - May 2nd - 3rd, Chicago, IL

ACI’s Advanced Forum on Managed Care Disputes and Litigation offers an unparalleled learning experience, specifically designed for the MCO legal community. Attend and develop winning legal strategies and business best...more

Goodwin

DOJ Renews Focus on Private Equity Amid Record False Claims Act Enforcement

Goodwin on

2023 was another record year for False Claims Act enforcement. On February 22, 2024, the U.S. Department of Justice (DOJ) announced that the federal government and whistleblowers were party to a record number of FCA...more

Manatt, Phelps & Phillips, LLP

CMS Weighs in on the Use of Algorithms and Artificial Intelligence in Coverage Determinations

Apparently in light of recent litigation against Medicare Advantage (MA) plans, on February 6, 2024, CMS published responses to frequently asked questions (FAQs) regarding the use of algorithms and artificial intelligence in...more

McDermott Will & Emery

CMS Releases Guidance on Coverage Criteria, Use of AI and More

McDermott Will & Emery on

On February 6, 2024, the US Centers for Medicare & Medicaid Services (CMS) released a set of frequently asked questions (FAQs) related to Medicare Advantage (MA) coverage criteria and utilization management (UM) requirements....more

Mintz

EnforceMintz — Artificial Intelligence and False Claims Act Enforcement

Mintz on

Like most industries, the health care sector is grappling with the uses of artificial intelligence (AI) and what AI means for the future. At the same time, many health care companies already have integrated algorithms and AI...more

Hall Benefits Law

Lawsuit Claims UnitedHealthcare Uses AI to Deny Majority of Medicare Advantage Extended-Care Facility Claims

Hall Benefits Law on

As the healthcare industry has begun to use artificial intelligence (AI) algorithms in its claims determination process, litigation has ensued. In a recent class action lawsuit, plaintiffs claim that UnitedHealthcare used its...more

Benesch

2024 Outlook: Behavioral Health Trends

Benesch on

Healthcare systems are facing significant challenges in recruiting and retaining talent within the burgeoning field of behavioral health services, primarily due to competition from telehealth providers and inconsistent...more

Foley & Lardner LLP

2024 Predictions: Unveiling the future of healthcare mergers and acquisitions

Foley & Lardner LLP on

Today, a tale of two markets are seen in healthcare mergers and acquisition (M&A): the present (as reflected in the data about declining dealmaking) and the future (reflected in the increasingly positive outlook by...more

Holland & Knight LLP

Holland & Knight Health Dose: November 28, 2023

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Holland & Knight Health Dose is an in-depth weekly dose of legislative and regulatory insights to keep stakeholders abreast of happenings in Washington, D.C., impacting the health sector....more

Holland & Knight LLP

Holland & Knight Health Dose: November 7, 2023

Holland & Knight LLP on

Holland & Knight Health Dose is an in-depth weekly dose of legislative and regulatory insights to keep stakeholders abreast of happenings in Washington, D.C., impacting the health sector....more

McDermott+

McDermottPlus Check-Up: November 3, 2023

McDermott+ on

CONGRESS - House Ways & Means Chair Smith, House Energy & Commerce Chair Rodgers and Senate Finance Ranking Member Crapo Call for Withdrawal of Nurse Staffing Mandate. Rep. Smith (R-MO), Rep. Rodgers (R-WA) and Sen. Crapo...more

Foley & Lardner LLP

HLTH 2023 Conference: Key Investing Takeaways

Foley & Lardner LLP on

A panel discussion moderated by Sofia Guerra of Bessemer Venture Partners aptly titled “The Great Leveling Out” provided some clear insights into how investors view the current state of play in digital health markets. Laura...more

American Conference Institute (ACI)

[Event] 2nd Annual Legal, Regulatory and Compliance Summit on Medicare Advantage - November 2nd - 3rd, Nashville, TN

Hosted by American Conference Institute, the 2nd Annual Legal, Regulatory and Compliance Summit on Medicare Advantage returns for another exciting year with curated programming that will address the latest oversight and...more

Holland & Knight LLP

Holland & Knight Health Dose: November 22, 2022

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Holland & Knight Health Dose is an in-depth weekly dose of legislative and regulatory insights to keep stakeholders abreast of happenings in Washington, D.C., impacting the health sector. This week's topics include: ...more

Health Care Compliance Association (HCCA)

[Virtual Event] 2021 Research Compliance Conference - June 14th - 16th, 9:00 am - 5:00 pm CDT

Attend HCCA’s annual Research Compliance Conference to receive the latest insights and guidance on emerging research compliance risks and solutions. This virtual event, held June 14 – 16, will be live and interactive. Learn...more

Epstein Becker & Green

7 Hot Health Care Industry Sectors for Investment, Growth & Consolidation in 2020

Based on their extensive experience advising health care industry clients, Epstein Becker Green attorneys and strategic advisors from EBG Advisors are predicting the “hot” health care sectors for investment, growth, and...more

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