• The 10 largest payers in the US by market share

    UnitedHealthcare Group, which has an annual revenue of $324 billion, is the largest health insurance company in the U.S. by market share, according to a report from ValuePenguin updated in October. 
  • Ohio system cuts ties with Anthem, Humana Medicare Advantage plans

    Zanesville, Ohio-based Genesis HealthCare System will no longer accept Anthem or Humana Medicare Advantage plans beginning in 2024. 
  • Ascension Saint Thomas ASC now part of Farm Bureau Medicare Advantage network

    Columbia, Tenn.-based payer Farm Bureau Health Plans has added Nashville, Tenn.-based Ascension Saint Thomas to its Medicare Advantage provider network. 
  • What to know about Stark law's $9.2M record in self-disclosures 

    CMS settled a record-breaking $9.29 million in Stark law voluntary self-referral disclosure settlements in 2022, according to recent CMS data.
  • WVU Medicine adds in-house Medicare Advantage plan

    Morgantown-based West Virginia University Medicine has launched an in-house health insurance services company, Peak Health, which has been serving WVU Medicine employees. Now, the system is expanding its offerings to Medicare-eligible patients throughout the state, according to an Oct. 19 report from The Weirton Daily Times. 
  • ASC's physician bonus structure avoids kickback issues, OIG says

    HHS' Office of the Inspector General has confirmed broad protection of employee safe harbor under anti-kickback laws in a recent ruling involving physician ownership of an ASC, according to an Oct. 17 article in JDSupra written by law firm Sheppard Mullin. 
  • Physicians urge CMS to stop policy that could drastically reduce reimbursements

    CMS is floating the implementation of a separate add-on payment for healthcare common procedure coding system code G2211 in its 2023 Medicare Physician Fee Schedule, according to an Oct. 13 report in JDSupra written by law firm Reed Smith. 
  • Here is what 3 major payers have been up to this month

    From negotiating new contracts to expanding plans, here are five moves from these three major payers since Oct. 2: 
  • Cigna to pay $172M over alleged Medicare Advantage overpayments

    Health insurer Cigna has been ordered to pay over $172 million to settle claims that it submitted false diagnosis codes to Medicare Advantage, according to an Oct. 2 report from CBS News.
  • Cigna expands Medicare Advantage plan to Nevada

    Cigna healthcare is expanding its Medicare Advantage plans to patients in Nevada for the first time, launching in two counties in the Las Vegas area. 
  • Aetna Medicare Advantage audit discovers $25.5M in overpayments in 1 year

    This year, the U.S. Office of the Inspector General conducted an audit of insurer Aetna's Medicare Advantage program to ensure that selected diagnosis codes Aetna submitted to CMS for use in CMS' risk adjustment program complied with federal requirements. 
  • Virginia health system ends Medicare Advantage plans

    Fredericksburg, Va.-based Mary Washington Healthcare will no longer offer Medicare Advantage plans beginning next year, citing rising costs, operational challenges and the impact of COVID-19, according to an Oct. 11 report from The Free Lance-Star.
  • The Hidden Perils of Silent PPOs: A Challenge for Healthcare Providers

    While PPOs are generally considered beneficial for providers due to the promise of a broader patient base, silent PPOs bring forth an array of hidden pitfalls and challenges they pose for healthcare providers.
  • Another health system could go out of network with UnitedHealthcare

    Louisville, Ky.-based Baptist Health could be going out of network with UnitedHealthcare for certain Medicare enrollees after its contract with the payer expires on Jan. 1, according to an Oct. 6 report from WDRB.
  • University Hospitals launches in-house Medicare Advantage plan

    Cleveland, Ohio-based University Hospitals has launched a co-branded Medicare Advantage Plan for individuals in three Ohio counties in partnership with PrimeTime Health Plan. 
  • UnitedHealthcare in the headlines: 5 notes

    UnitedHealthcare is one of the country's largest payers.
  • Health system-payer disputes: 3 moves for ASCs to know

    ASCs are not the only entities that struggle to strike deals with payers. 
  • 7 Reasons Why Cardiovascular ASCs Should Outsource Their Billing

    Cardiology is one of the fastest-growing ambulatory surgery center (ASC) specialties, and we're seeing the development of new cardiovascular ASCs nationally. Fueling the rise of cardiology in the ASC industry is the addition of different types of cardiovascular procedures to the ASC Covered Procedure List (CPL) over the past several years.
  • 5 notes on noncompetes

    Almost 30 million U.S. workers have noncompete provisions in their contract, according to an Oct. 4 report from U.S. News & World Report.
  • Maryland tightens noncompete policy

    Maryland employers are barred from noncompete provisions for certain employees, according to an Oct. 3 article about state and local employment developments published in JDSupra and written by law firm Faegre Drinker Biddle & Reath. 

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