healthcarelabyrinth

Logo

April 22, 2024

United Did Pay Ransom In Cyberattack United HealthGroup confirmed that personal health information (PHI) and personally identifiable information (PII) was exposed in the attack and “could cover a substantial proportion of people in America.” It also confirmed a ransom was paid. It will take awhile to get to what was exposed and who was impacted. Experts have data which points to the payment of a $22 million ransom by United.  United confirms that while some systems are functioning near normal, others are not yet up and will be restored over time. In additional news, the United CEO will appear before a House subcommittee on May 1: https://www.reuters.com/business/healthcare-pharmaceuticals/unitedhealth-ceo-testify-before-us-house-panel-cyberattack-tech-unit-2024-04-19/ . Additional article: https://www.modernhealthcare.com/cybersecurity/change-healthcare-update-unitedhealth-ransom (Some articles may require a subscription.) #united #changehealthcare #cyberattacks https://www.fiercehealthcare.com/payers/unitedhealth-offers-update-cyberattack-data-analysis-systems-restoration Sweeping Medicaid Manage Care Rule Finalized The Centers for Medicare and Medicaid Services (CMS) finalized Medicaid managed care rules today that cover a number of critical areas, including requiring

Read More »
Logo

April 19, 2024

Optum Appears To Be Laying Off Employees Over Cyberattack Given the fallout from the Change Healthcare cyberattack, Optum appears to be laying off hundreds if not thousands of employees.  United HealthGroup has not commented on the matter at this point. I have heard that some of the laid off employees are even within the Change Healthcare unit, which could be impacting the return to normal business operations for some plans and providers. If this is true, that is outrageous. #changehealthcare #optum #cyberattacks https://www.fiercehealthcare.com/payers/optum-undergoes-mass-layoffs-scale-unclear Continued Fallout Over Change Healthcare Cyberattack Good Kaiser Health News article on the continued fallout over the Change Healthcare cyberattack.  United tries to put the best face on the issue, saying that in many cases it is seeing normal operations.  But this article shows that many healthcare entities continue to see huge impacts on cash flow and their ability to bill.  I have personally been in contact

Read More »
Logo

April 18, 2024

Elevance Health Reports Positive Q1 News Elevance Health reported overall good numbers for Q1 2024.  While membership has dropped in Medicare Advantage (MA) and Medicaid, margins were up and it reported little fallout on the Medicare medical expense or Change cyberattack front. Due to the MA rate cut, Elevance will balance business expansion with margin. On the call, the CEO also discussed the need to excel at Star measurement in MA.  It also continues to build its Carelon services unit. Additional articles: https://www.fiercehealthcare.com/payers/elevance-health-sees-double-digit-profit-growth-q1-posting-22b-earnings and https://www.modernhealthcare.com/insurance/elevance-health-medicaid-medicare-advantage-earnings (Some articles may require a subscription.) #elevancehealth #medicareadvantage https://www.healthcaredive.com/news/elevance-health-earnings-q1-change-cyberattack-medicaid-medicare-advantage/713521 Lawmaker-Physician Burgess Calls For Site-Neutral Policies Retiring Rep. Michael Burgess, a physician, is calling on the Biden administration to implement site-neutral payments for hospitals, arguing it could be a way to free up dollars to overhaul the physician payment formula in Medicare and lower overall costs.  He is right! I am not always sympathetic to physicians,

Read More »
Logo

April 17, 2024

Many Healthcare Bankruptcies Linked To PE Firms I often talk about the pernicious impact that private equity firms have on healthcare.  Where the firms are successful, they tend to drive up costs in the system by buying provider groups, including owning emergency room providers, and pushing for huge payouts in No Surprises Act (NSA) arbitrations.  They also own hospitals where they cut costs due to high debt. Quality of course suffers and patient care takes a back seat. Such firms also force providers to practice at high-cost hospital places of service (the same is true for hospitals who are independent but are buying up doc groups). But the other pernicious impact is on shoddy investments and the churn and fallout that occurs.  PE firms tend to saddle the entities they buy with debt.  What’s more, some of the investments are questionable and speculative.  A new report says that more than

Read More »
Logo

April 16, 2024

Affiliate Of BlackCat Reportedly Published PHI From Change Cyberattack While the main operator of BlackCat ransomware appears to have kept a rumored $22 million ransom paid by United HealthGroup, an affiliate published data from the Change Healthcare cyberattack after United did not pay an additional ransom.  The affiliate controlled the captured PHI and data. #changehealthcare #cyberattacks https://www.fiercehealthcare.com/payers/optums-change-healthcare-responding-cybersecurity-issue United Reports Stabilization of MA And Costs Of Cyberattack United HealthGroup reported two critical factors on Tuesday.  First, Medicare Advantage (MA) costs have stabilized in Q1 2024.  Second, the Change Healthcare cyberattack will cost up to $1.6 billion.  The costs will likely far exceed this estimate. Additional articles: https://www.modernhealthcare.com/insurance/change-healthcare-update-cyberattack-cost-unitedhealth and https://www.healthcaredive.com/news/change-cyberattack-unitedhealth-cost-q1-earnings/713288/ and https://www.beckerspayer.com/payer/medicare-advantage-costs-begin-to-stabilize-unitedhealth-says.html (Some articles may require a subscription.) #unitedhealthcare #changehealthcare #cyberattacks #medicareadvantage https://www.fiercehealthcare.com/payers/unitedhealth-says-seasonal-pressures-ma-utilization-eased-q1 Lawmakers Receptive To Provider Recommendations On Cyber Security With United HealthGroup declining an invitation to attend a congressional hearing, lawmakers largely were empathetic to providers’ views on the cyber

Read More »
Logo

April 15, 2024

Some Big Insurers May Lose Medicaid Contracts In Florida Humana, Centene, and Elevance Health were the three big plans to win Florida Medicaid awards moving forward along with a number of local plans. But UnitedHealthcare, Aetna, Molina Healthcare, and AmeriHealth Caritas Florida were not given awards. Many states are seeking to cultivate local plans. Appeals will likely follow from the three big plans not selected. Additional article here: https://www.fiercehealthcare.com/payers/unitedhealth-cvs-molina-big-losers-florida-medicaid-contract-awards #medicaid #fl #managedcare #healthplans https://www.healthcaredive.com/news/florida-medicaid-awards-centene-elevance-humana-unitedhealth-cvs-molina/713154 Carelon And Private Equity Firm Partner On Primary Care Elevance Health announced that its service unit Carelon will partner with private equity firm Clayton, Dubilier & Rice and its assets, Apree Health and Millennium Physician Group on advancing primary care.  About 1 million will be covered. The move seeks to drive a close relationship between primary care and Elevance as an insurer.  The move is a bit of a surprise given the extreme focus on private equity’s

Read More »
Logo

April 12, 2024

Physician Pay Increases, But Hurt By Inflation A survey of physicians shows that pay increased by about 3% in 2023, but it was offset by high inflation. #physicians #providers https://www.fiercehealthcare.com/providers/physician-pay-rose-modest-3-2023-here-are-specialties-saw-biggest-gains Corporate And Hospital Ownership Of Physicians Continues I often talk about the pernicious effect of hospital and private equity ownership on healthcare costs. Hospitals drive changes in practice to higher-cost settings.  Together, the entities continually push fees higher. The ugly effects of the takeover of independent practices continues.  Not too long ago, studies showed about half of all physician entities owned by hospitals or private corporations and about 70% of all physicians employed by them.  Now, the latest stats show the two types of entities owning 58.5% of all physician entities.  They now own 77.6% of all physicians. For the first time, corporate practice ownership (30.1%) exceeded hospital and health system ownership of docs (28.4%). Additional article: https://www.fiercehealthcare.com/providers/more-and-more-physicians-are-working-under-hospitals-corporate-entities-report-finds #physicians #providers

Read More »
Logo

April 11, 2024

New Alzheimer’s Drug Spending Will Leap In Medicare The Centers for Medicare & Medicaid Services (CMS) says spending on the new Alzheimer’s drug Leqembi will leap well over estimates. CMS estimates that per member per month spending on Leqembi will rise from $1.67 in 2024 to $4.67 in 2025. This will bring spending across all Medicare to $3.5 billion in 2025. This threatens to add demonstrably to Medicare troubles and will hike Part B premiums. #drugpricing https://www.fiercehealthcare.com/regulatory/report-cms-projects-spending-leqembi-will-hit-35b-next-year Federal Appeals Court Reinstates Denial Case Against United A federal appeals court allowed a proposed class action lawsuit to continue. The case alleges that UnitedHealth Group used an algorithm to more stringently review patient claims for substance abuse treatment. Both prior authorization and medical claims denials are being closely scrutinized right now. (Article may require a subscription.) #priorauthorization #claimsdenials https://www.modernhealthcare.com/legal/unitedhealth-behavioral-health-lawsuit-substance-abuse Bipartisan Support For Medicare Doc Fix Senate Finance Chair Ron Wyden, D-OR, and

Read More »
Logo

April 10, 2024

Community Health Centers Suffering From Medicaid Disenrollment A new study of patients at community health centers are reporting major Medicaid disenrollments, which impacts the level of care that can be provided to these individuals.  Community health centers largely serve those in low-income areas. It also finds that about 75% of people who have lost Medicaid coverage are still disenrolled. Further, 32% have chronic conditions, 24% are children, 12% were adults older than 65 years of age and 12% had disabilities. #medicaid redeterminations #primarycare https://www.fiercehealthcare.com/payers/one-year-after-unwinding-community-health-centers-struggle-medicaid-reenrollment Provider Impacts Continue From Cyberattack Physicians continue to see major impacts due to the Change Healthcare cyberattack. This comes from an American Medical Association (AMA) survey of more than 1,400 individuals. Over 77% of those surveyed said they experienced service disruptions beginning Feb. 21 and still feel impacts. Over a third (36%) saw claims payments suspended and 32% have not been able to submit claims. About

Read More »
Logo

April 9, 2024

CMS Cuts Off Broker Access To SSNs Kudos for Kaiser Health News’ articles and focus on fraudulent switching in the Exchanges by untrustworthy agents.  The trend has caused a lot of misery for enrollees.  One problem was the access by agents and brokers to full social security numbers (SSNs).  As of today, that has been cut off by the Centers for Medicare and Medicaid Services (CMS) in the federal Marketplace.  Henry Kaiser is smiling from heaven. #kff #khn #fwa #exchanges #aca Link to Article Advocates And Insurers Urge Extension Of ACA Premium Enhancements For One Year Advocates and insurers are right that Congress should extend the enhanced premium subsidies for the Exchanges sometime in 2024.  They are set to expire Dec. 31, 2025, but should be extended to the end of 2026.  Why? Because plans submit proposed benefits and rates in early 2025 for 2026. If the premium enhancements are

Read More »

Available Now

$30.00