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Healthcare E-Alerts

Medicare Advantage and Part D: CMS Issues Final Rule

We recently brought an alert dealing with allegations against Medicare Advantage (MA) to the effect that MA plans were more prone to deny claims or delay payments when compared to Medicare or third-party payers. Medicare Advantage is back in the news—but, this time, for another reason. Last week, the Centers for Medicare and Medicaid Services […]

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The Meaning of Consent: The Government Provides New Clarification

In the opening lines of Pink Floyd’s trippy hit, Comfortably Numb, the doctor instructs the patient to provide a response, saying: “just nod if you can hear me.” While not an exact example of what the medical industry means by “informed consent,” it does help us to think about what that term means. What are the […]

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Taking Advantage: Sending a Message to Medicare Advantage

We’re supposed to play by the rules but not everybody does. That’s especially disappointing when that person works for the government. Recently, a former state insurance commissioner pleaded guilty to healthcare fraud. How ironic—the very person entrusted with safeguarding the consumer against insurance fraud goes on to engage in a $2.5 million scheme involving false […]

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Rebuilding and Restoration: UHG Makes Strides in Wake of Cyberattack

One of things that keeps life interesting is the release of new information. Americans have access to multiple cable news outlets and innumerable headline sources on the web and in print. Sometimes the information is distressing and sometimes it can be heartening. Today’s alert may be seen by many as an example of the latter. […]

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Washington to the Rescue: Help to Hospitals in Wake of Cyberattack

In an attempt to address in some meaningful way the serious impact of last month’s cyberattack against Optum’s Change Healthcare—which went on to create ripples in the stability of the nation’s overall healthcare system—the Centers for Medicare and Medicaid Services (CMS) issued this past Saturday an announcement that it was providing immediate help. The agency […]

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Cyber Attack Against Optum’s Change Healthcare: What Our Clients Need to Know 

As many of you know, Change Healthcare was the target of an apparent cyberattack this past Wednesday. The revenue cycle company, which is a subsidiary of UnitedHealth Group’s Optum, indicated that it had managed to “isolate its systems” to mitigate further harm. Optum, UnitedHealthcare, and UnitedHealth Group (UHG) systems were not affected by the attack, […]

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Are Clinical Texts Acceptable? CMS Weighs in

We all do it. Unless you’re physically impaired or living off the grid in the wilds of Alaska, most adults will communicate by way of texting at some point in a given year. For many of us, it is a daily occurrence. Interesting how methods for delivering the written word have morphed over the years, […]

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New Final Rule from CMS: Improving Interoperability and Prior Authorization

The wheels never stop. The gears of government are always turning—churning out new rules for the rest of us to live by. Final rules are never final, and the last word is never spoken because there is always something more to say. The latest final rule addressed below provides a case in point. It acts […]

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Federal Focus on EMTALA: HHS Goes on the Offensive

On Jan 22, 2024, the Department of Health and Human Services (HHS) put out a press release, announcing that it will launch new initiatives in support of the Emergency Medical Treatment and Labor Act (EMTALA). The law, passed back in 1986, requires hospitals with emergency departments to adhere to a certain set of standards, to […]

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