California is leading the way in ensuring that determinations of medically necessary health care services are made by licensed physicians and not artificial intelligence (AI) algorithms....more
1/31/2025
/ Artificial Intelligence ,
California ,
Class Action ,
Compliance ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Insurance Industry ,
New Legislation ,
Physicians ,
Regulatory Agenda
Now is the time for health care providers to consider participating in the recent Blue Cross Blue Shield (BCBS) antitrust class action settlement and the newly filed antitrust cases alleging widespread price fixing for...more
On August 2, health care providers scored yet another significant victory when the US Court of Appeals for the Fifth Circuit affirmed the vacatur of various federal regulations regarding the arbitration procedures used to...more
8/8/2024
/ Arbitration ,
Arbitrators ,
Certiorari ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Dispute Resolution ,
Final Rules ,
Health Care Providers ,
Insurance Industry ,
No Surprises Act (NSA) ,
Reimbursements ,
SCOTUS ,
U.S. Treasury
Change Healthcare, an affiliate of Optum and UnitedHealth Group, processes more than 15 billion health care transactions annually and touches one of every three patient records. On February 21, Change disconnected its...more
3/15/2024
/ American Medical Association ,
Centers for Medicare & Medicaid Services (CMS) ,
Cyber Attacks ,
Cybersecurity ,
Health Care Providers ,
Healthcare ,
Insurance Industry ,
Medicare Part B ,
Payment Systems ,
Policies and Procedures ,
Popular ,
Prescription Drug Coverage ,
Prescription Drugs ,
Ransomware
On December 18, 2023, the US Departments of Treasury, Labor, and Health and Human Services (the Departments) issued a rule finalizing the 2024 non-refundable administrative fee parties must pay to access the arbitration...more
With the surge of interest in artificial intelligence (AI), it should be no surprise that health insurers have come under scrutiny concerning their use of AI predictive tools to deny medical insurance claims.
The question...more
12/22/2023
/ Algorithms ,
Artificial Intelligence ,
Automated Decision Systems (ADS) ,
Beneficiaries ,
Breach of Duty ,
CIGNA ,
Class Action ,
Health Care Providers ,
Health Insurance ,
Insurance Claims ,
Patients ,
United Healthcare Insurance Co.
On August 24, 2023, health care providers in Texas scored yet another victory when a federal court vacated additional portions of the Biden Administration’s rulemaking under the federal No Surprises Act (the Act). This marked...more
On August 3, 2023, health care providers in Texas scored yet another victory when a federal court vacated additional portions of the Biden Administration’s rules governing fee collection and claim batching under the federal...more
8/22/2023
/ Administrative Procedure Act ,
Arbitration ,
Biden Administration ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Dispute Resolution ,
Fees ,
Health Care Providers ,
Rulemaking Process ,
Surprise Medical Bills ,
U.S. Treasury
On February 5, 2020, the Centers for Medicare and Medicaid Services (CMS) proposed removing long-standing prohibitions and eligibility restrictions that had barred many individuals with End-Stage Renal Disease (ESRD) from...more
2/11/2020
/ 21st Century Cures Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Eligibility ,
Health Care Providers ,
Health Insurance ,
Health Plan Sponsors ,
Medicare ,
Medicare Advantage ,
Proposed Rules ,
Public Comment
On September 10, 2019, the Centers for Medicare and Medicaid Services (CMS) issued a final rule with comment period, titled Program Integrity Enhancements to the Provider Enrollment Process (the “Final Rule”), which enhances...more
9/30/2019
/ Affiliates ,
Bad Actors ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Comment Period ,
Disclosure Requirements ,
Enforcement Authority ,
Enrollment ,
Final Rules ,
Health Care Providers ,
Medicaid ,
Medicare ,
Reporting Requirements