October 10, 2024
Nona Tepper
Tim Broderick
The Centers for Medicare and Medicaid Services sought to make it more challenging for Medicare Advantage insurers to win top quality scores and the payment bonuses that go along with them. It’s working.
On Thursday, CMS released the latest Medicare Advantage star ratings, and the contrast to just a few years ago is stark. In 2022, 74 Medicare Advantage with prescription drug coverage contracts garnered five-out-of-five stars. For the 2025 plan year, only seven did.
October 07, 2024
Lauren Berryman
Next year’s Medicare Advantage landscape appears relatively stable on the surface. But beneath that lie notable coverage cutbacks health insurers made to recover margins after a turbulent year.
The large number of Medicare Advantage plans available for 2025 and a lower average premium tell one story. Insurers exiting geographic markets, reducing benefits and imposing higher out-of-pocket costs reveal another. Just over half of nearly 67 million Medicare beneficiaries are on Medicare Advantage and open enrollment begins a week from Tuesday.
September 18, 2024
Katherine Davis
Chicago-based healthcare firm Oak Street Health has agreed to pay $60 million to resolve allegations from the U.S. Department of Justice that it paid kickbacks to third-party insurance agents in exchange for recruiting seniors to Oak Street’s primary care clinics.
The DOJ alleged in a statement today that Oak Street’s Client Awareness Program, designed to grow patient membership, had third-party insurance agents contacting seniors eligible for or enrolled in Medicare Advantage plans, seeking to recruit them to Oak Street locations.
September 04, 2024
Bridget Early
Gabriel Perna
Telehealth industry and mental health groups are scrambling amid fears the Drug Enforcement Administration is poised to place strict limits on remote prescribing of controlled substances such as Adderall and Vicodin.
The legal authority for clinicians to prescribe DEA-regulated medications through platforms such as Talkiatry expires in less than four months, and the law enforcement agency has moved slowly to issue a final rule after the draft version released last year triggered protests from providers and telehealth companies.
August 20, 2024
Caroline Hudson
The Federal Trade Commission does not have authority to enact its ban on noncompete agreements, a federal judge ruled Tuesday.
Judge Ada Brown wrote the FTC’s near-total ban is “unreasonably overbroad without a reasonable explanation,” siding with the U.S. Chamber of Commerce and tax firm Ryan LLC. Many healthcare organizations include noncompete agreements in employment contracts.
August 15, 2024
Nutile Law attorney Maria Nutile was recently recognized by Best Lawyers as the 2025 “Lawyer of the Year” for Health Care Law in the Las Vegas area.
Only a single lawyer in each practice area and designated metropolitan area is honored as the “Lawyer of the Year,” making this honor especially significant. Recognition by Best Lawyers is based entirely on peer review and reflects the high level of respect a lawyer has earned among other leading lawyers in the same communities and the same practice areas for their abilities, professionalism, and integrity.
July 25, 2024
MICHAEL MCAULIFF
Envision Healthcare, a top private equity-backed emergency physician staffing company, is exiting California and avoiding a lawsuit that threatened the legality of its business model in the state.
The Nashville, Tennessee-based company had been battling the American Academy of Emergency Medicine, which sued in 2021 after Envision Healthcare won a contract that the American Academy of Emergency Medicine Physician Group previously held at Placentia-Linda Hospital in Placentia, part of the Orange-based University of California, Irvine Health system.
July 22, 2024
BROCK E.W. TURNER
HAYLEY DESILVA
GABRIEL PERNA
Health systems and hospitals expect many applications, computers and other systems to be back online early this week after Friday’s global CrowdStrike outage.
On Sunday, large systems including Salt Lake City-based Intermountain Health, Cleveland Clinic and Renton, Washington-based Providence said their systems were fully functional, or they expected them to be by Monday.
July 17, 2024
ALEX KACIK
Health systems are rethinking their use of noncompete agreements despite a Texas court ruling that may doom the Federal Trade Commission’s ban on those employment contract provisions.
Companies are girding for more litigation, regulation and legislation seeking to limit noncompetes, even if the FTC’s effort to eliminate those agreements falls short, attorneys said. Many healthcare employers are turning to nondisclosure and nonsolicitation provisions in place of noncompete clauses that restrict employees from working for a rival organization. If employers are still using noncompetes, physicians and other healthcare workers are increasingly pushing back, employment lawyers said.
June 27, 2024
BROCK E.W. TURNER
The federal government is warning providers and public health entities about certain types of cyber attacks and advising them not pay ransoms.
An advisory issued this week by the Health and Human Services Department and the FBI said criminals are using social engineering campaigns to target healthcare, public health entities and providers. Phishing schemes are being used to steal login credentials that give bad actors access to payment information.