claims
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Bon Secours Mercy Health Sues Anthem Health Plans of Virginia for Unpaid Claims
In a new lawsuit, Bon Secours Mercy Health Virginia alleges that Anthem Health Plans of Virginia owes the health system more than $93 million in outstanding unpaid and underpaid claims.
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DOJ accuses Kaiser Permanente of Medicare Advantage fraud in new complaint
The California-based health system and insurer has bilked CMS out of “hundreds of millions of dollars” by submitting claims that were altered to make patients appear sicker than they were, a new complaint filed by the DOJ alleges. Kaiser denied these allegations saying it is confident in its compliance with Medicare Advantage program requirements.
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Payer’s Place: Dr. Anil Singh
Dr. Anil Singh shares his insights into the strategies employed by the organization to identify the most effective digital solutions for their members.
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UnitedHealth subsidiaries settle mental health parity allegations for $15.6M
UnitedHealthcare and United Behavioral Health agreed to the settlement to resolve allegations that they illegally denied coverage for mental health and substance use disorder treatments. The allegations are related to business practices they no longer use, parent company UnitedHealth Group said.
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BCBS of Kansas City sues Covid-19 testing provider over alleged price gouging
GS Labs, a Covid-19 testing provider, has submitted over $9.2 million in claims to the insurer as a result of its grossly inflated prices, the lawsuit states. The testing company rejected the claims, saying its “prices accurately reflect the level of service” it provides.
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UnitedHealthcare nixes some out-of-network coverage for non-emergencies
Per a policy update that went in to effect July 1, the health insurance giant is not covering non-emergency services that members receive at out-of-network facilities that are outside of their service area. This update mainly affects residential treatment facilities, inpatient rehabilitation and other non-hospital-based services.
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Emergency physicians oppose new UnitedHealth policy enabling retroactive ED claims denial
UnitedHealthcare is instituting a new policy beginning July 1 that changes how the payer assesses emergency department claims, allowing it to retroactively deny ones it deems “non-emergent” or not an emergency. The American College of Emergency Physicians has made its opposition clear, stating the policy may violate federal law.
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Aetna accuses Mednax of destroying evidence in overbilling suit: 5 things to know
In a lawsuit filed three years ago, Aetna alleged that Mednax had overbilled for medical procedures and services. Now, the insurer is accusing the medical group of destroying evidence pertaining to the suit and has asked a federal court to sanction Mednax.
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UnitedHealth must reprocess thousands of illegally denied mental health claims, judge orders
In a trial last year, a federal judge found that a UnitedHealth subsidiary had illegally denied mental health and substance use disorder claims. The same judge has now ordered the payer to reprocess all the claims and reform its guidelines.
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Employee Benefits, Legal, Payers
Lawsuits accuse United, Cigna of underpaying for behavioral health claims
Four class action suits filed in early April accuse United Behavioral Health and Cigna Behavioral health of underpaying providers for mental health services. They allegedly used a third-party vendor called Viant to negotiate claims.
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Discover the Next-Gen Platform for Integrated Collaborative Care
Beyond EHRs and digital front doors, reducing the gaps in patient care journeys.