Legal & Regulatory Issues

Attorneys representing Methodist Le Bonheur Healthcare are asking a federal court to prevent the Justice Department from intervening in a false claims lawsuit filed by whistleblowers against the Memphis, Tenn.-based health system, according to the Commercial Appeal.

Anthem is asking Virginia state regulators to investigate alleged anticompetitive behavior from Norfolk, Va.-based Sentara Healthcare after the provider threatened to end its contract with Anthem's Medicare and Medicaid lines of business. 

The Senate Finance Committee held a hearing titled "Health Insurance Coverage in America: Current and Future Role of Federal Programs" on Oct. 20, where lawmakers and witnesses spoke on the state of health insurance in America. 

Two Texas physicians agreed to pay $3.9 million to resolve allegations they submitted false claims to government insurers for medically unnecessary urine drug testing, the Justice Department said Oct. 22.

Johns Hopkins Medicine's insurance arm, Hopkins Health Advantage MD, is cutting back its reach, dropping about 5,000 customers in Baltimore and Calvert County, Md., The Baltimore Sun reported Oct. 22.

President Joe Biden said during an Oct. 21 town hall that expanding Medicare would be an uphill battle.

In a lawsuit filed in the U.S. District Court Oct. 20, parents in nine Western Pennsylvania communities allege that they are met with blanket refusal from UPMC physicians to sign medical exemptions allowing their children to attend school without masks. 

After receiving pushback from retirees, New York City's new Medicare contract for city retirees will be paused indefinitely, a state Supreme Court judge ruled Oct. 21. 

A report from Rob Sand, Iowa's auditor of state, found that privatizing the state's Medicaid program in 2016 resulted in an 891 percent increase in patients who were allegedly illegally denied care. 

A new piece of bipartisan legislation introduced in the Senate is looking to revamp the prior authorization process for Medicare Advantage beneficiaries.