Regulatory

US to Prioritize Private Equity’s Role in Healthcare Fraud

The Justice Department is focusing on private equity’s role in causing healthcare fraud, the head of the Civil Division said Thursday. “We have already had a few cases involving private equity firms, and given the significant role that private equity is increasingly playing in the healthcare field, we anticipate that their impact on healthcare billings […]

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Community Health Systems Discloses DOJ investigation

Community Health Systems (CHS) disclosed in a Securities and Exchange Commission filing that it is being investigated by the Department of Justice. The company received a Civil Investigative Demand on Jan. 11 “for documents and information relating to a variety of subjects, including practices and procedures related to utilization review, inpatient admissions and inpatient dialysis

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Supreme Court Rejects UnitedHealth Appeal, Boosting Behavioral Health Providers’ Standing with Insurers

The U.S. Supreme Court rejected a request by United Behavioral Health to hear a behavioral health claim denial case. The case, titled D.K. v. United Behavioral Health, centered on findings that the health plan did not give plaintiffs a full and fair review during the denial-appeals process. The Supreme Court’s decision allows two rulings favorable

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Alabama Supreme Court Ruling Adds to Legal Uncertainty around IVF

The Alabama Supreme Court’s ruling that frozen embryos are children creates new legal murkiness around in vitro fertilization. The ruling, the first time a court has recognized frozen embryos as human beings, raises vast legal questions in the post-Roe landscape, including how and if leftover embryos can ever be disposed of. Fertility providers and legal

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No Surprises Implementation Created Uptick in In-Network Claims: Fair Health

After federal legislation protecting consumers from surprise medical bills was implemented, a growing number of medical claims were in network, according to a new analysis. The No Surprises Act went into effect on Jan. 1, 2022. From the fourth quarter of 2021 to the first quarter of 2022, in-network care as a percentage of all

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MA Governor Orders Steward Health Care to Disclose Withheld Financial Documents, Says It Must Exit State ‘As Soon as Possible’

After weeks of public and policymaker scrutiny, Massachusetts Governor Maura Healey has told Steward Health Care CEO Ralph de la Torre, M.D., that his floundering system should begin handing off its licensed healthcare facilities to new operators “as soon as possible” and threatened to redirect patients from those where staffing and supply levels are insufficient.

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