Government, Health Care / Medicine
Congressman Launches Investigation Into Medicaid Prior Authorization Denials
By
MARISSA PLESCIA - MEDCITY NEWS
U.S. Representative Frank Pallone, Jr. (D-New Jersey) announced that he is looking into high prior authorization denial rates by Medicaid managed care health plans. It follows a report by the Office of Inspector General that found that Medicaid MCOs denied one out of every eight prior authorization requests in 2019.
Courts, Health Care / Medicine
43K Patients In California Could Get Refunds, Bill Corrections As Part Of Discounted Care Settlement
By
KATIE ADAMS - MEDCITY NEWS
Santa Clara Valley Healthcare in California has begun notifying 43,000 patients about their eligibility for billing corrections and refunds. The system’s patient outreach effort is a result of a recently settled lawsuit. In the complaint, former patients alleged the county did not inform them about its hospitals’ charity care and discount payment policies, leading them to have to pay large bills.
Government, Health Care / Medicine
House Reps Introduce Bill To Ease State Medicaid Staffing Shortages Amid Redeterminations
By
MARISSA PLESCIA - MEDCITY NEWS
The bill would allow state Medicaid agencies to hire outside contractors to help with Medicaid redeterminations, as many agencies don’t have the workforce to handle the return to the redetermination process.
Government, Health Care / Medicine
HHS Launches Civil Rights Investigation Into Vanderbilt’s Sharing Of Transgender Patient Data
By
KATIE ADAMS - MEDCITY NEWS
Vanderbilt University Medical Center is under federal investigation after it turned transgender patients’ medical records over to Tennessee’s attorney general. HHS launched the investigation a couple weeks after two VUMC patients filed a class-action lawsuit against the hospital for releasing their records to the attorney general.
Government, Health Care / Medicine
Senator Probes Google About ‘Premature Deployment Of Unproven Technology’ In Healthcare Settings
By
KATIE ADAMS - MEDCITY NEWS
Senator Mark Warner (D-Virginia) penned a letter to Google leadership expressing concerns about Med-PaLM 2 — the company’s generative AI tool for healthcare providers that is currently being used by Mayo Clinic and other health systems.
Finance, Health Care / Medicine
Healthcare M&A Activity Reaches 3-Year Low, But It Might Pick Up In The Back Half Of ‘23
By
KATIE ADAMS - MEDCITY NEWS
M&A activity in the healthcare sector continued to decline in the second quarter of 2023, with the number of deals reaching its lowest point in three years. However, a new report predicted that M&A activity could increase in the second half of this year due to healthcare companies’ continually shrinking valuations and their divestitures of non-core assets.
Courts, Health Care / Medicine
Nektar Sues Eli Lilly, Claiming The Big Pharma Breached Contract To Favor Another Drug
By
FRANK VINLUAN - MEDCITY NEWS
The biotech claims its former partner tried to disadvantage the asset in order to advance development of another drug it acquired in a billion-dollar deal.
Health Care / Medicine
How Did The 3 Biggest For-Profit Hospital Chains Perform In Q2?
HCA and Tenet reported net incomes for the second quarter, while CHS posted a net loss. All three health systems found themselves in a better financial position in Q2 2023 than they were in Q2 of last year, driven in large part by declining contract labor expenses.
Health Care / Medicine
Hospitals Still Struggling To Get Back Online 4 Days After Cyberattack On Prospect Medical Holdings
Hospitals and outpatient treatment centers in at least three states are struggling to get their systems back online following a ransomware attack waged last week against parent company Prospect Medical Holdings. Some of these facilities have partially or completely halted patient care.
Courts, Health Care / Medicine
GSK Patent Suit Aims To Halt Pfizer’s RSV Vaccine For Adults, But Not Infants
By
FRANK VINLUAN - MEDCITY NEWS
GSK claims that Pfizer’s FDA-approved vaccine for respiratory syncytial virus infringes on four patents protecting its own approved vaccine, Arexvy. The patent suit comes with the RSV season approaching.
Health Care / Medicine
‘A Criminal Justice Approach To A Public Health Problem’: How The Justice System Can Improve SUD Support
By
MARISSA PLESCIA - MEDCITY NEWS
There is inadequate substance use disorder support for people who are incarcerated or are leaving incarceration. But there are opportunities to make improvements, experts say.
Courts, Health Care / Medicine
Labor Department Sues UnitedHealth Group Over ‘Thousands’ Of Claims Denials
By
KATIE ADAMS - MEDCITY NEWS
The Labor Department recently sued UnitedHealth Group subsidiary UMR, alleging that it wrongfully denied claims for emergency room services and urinary drug screenings since 2015. UMR did not determine the medical necessity of the claims, denying them ‘based solely on diagnosis codes and not applying a prudent layperson standard,’ according to the complaint.
Health Care / Medicine
‘We Can Be More Selective About Who We Treat’: UHS CFO’s Comments Spark Concerns About Cherry-Picking
By
KATIE ADAMS - MEDCITY NEWS
Last week, the CFO of Universal Health Services stated that the company chooses which patients to treat based on whose insurance plans offer the highest payments. The comments have sparked some media attention, but healthcare finance experts say the practice of cherry-picking patients is nothing new to the industry.
Health Care / Medicine
Average Healthcare Data Breach Cost Reaches Nearly $11M
By
KATIE ADAMS - MEDCITY NEWS
Healthcare has the highest data breach costs of all industries — breaches are second costliest in the financial sector, where the average cost is $5.9 million.
Government, Health Care / Medicine
The Biden Administration Proposes Rule To Improve Mental Health Parity
By
MARISSA PLESCIA - MEDCITY NEWS
A new proposed rule by the Biden-Harris Administration would require health plans to improve their analyses of their mental health benefits and make clear that they cannot engage in practices that make it more difficult for members to access mental health support compared to physical health.
Health Care / Medicine
Hospitals’ Price Transparency Compliance Is Improving Despite Remaining Low At 36%
By
KATIE ADAMS - MEDCITY NEWS
About 36% of U.S. hospitals are in compliance with CMS’ price transparency rule, up from 24.5% in February, according to a new report. This progress will remain slow unless CMS can do a better job of effectively enforcing its rule, the report declared.
Government, Health Care / Medicine
Coalition Applauds Reintroduction Of Obesity Treatment Bill, Urges Passage
By
MARISSA PLESCIA - MEDCITY NEWS
The Treat and Reduce Obesity Act would expand Medicare coverage for obesity screenings, treatments, and therapies like anti-obesity medications. The Health Equity Coalition for Chronic Disease came out in favor of the bill and asked for swift passage.
Courts, Health Care / Medicine
Startup Sues Athenahealth, Alleging Trade Secret Theft & Deceptive Practices
By
KATIE ADAMS - MEDCITY NEWS
Digital health startup Dorsata filed a lawsuit against EHR provider athenahealth and women’s health company Unified Women’s Healthcare. The startup alleged that athenahealth stole trade secrets, used deceptive business practices and breached its contract — and that Unified aided and abetted these purported practices.
Health Care / Medicine
Ticking The Talons Of Healthcare Transparency
By
PETER J. PITTS via MEDCITY NEWS
As of January 1, employer-sponsored Group Health Plans and Health Insurance Issuers must make make the prices of 500 medical services available via an Internet-based tool. The Transparency in Coverage final rule gets even tougher on January 1, 2024, when the prices of all medical services must be made available via an Internet-based tool.