Wednesday, August 2, 2023


Labor Department Sues A UnitedHealth Group Over Claims Denials

The lawsuit alleges UnitedHealth’s UMR unit denied thousands of medical claims without reviewing them for medical necessity. Separately, employers are fighting for billing data that health insurers won’t reveal. Also in the news: rising prices at independent hospitals.

Modern Healthcare: Labor Department Sues UnitedHealth’s UMR Over Denied Claims
A UnitedHealth Group unit denied thousands of emergency department and drug screening claims without reviewing them for medical necessity, the Labor Department alleges in a lawsuit initiated on Monday. The complaint filed in the U.S. District Court for the Western District of Wisconsin targets UMR, a third-party administrator within the company’s UnitedHealthcare subsidiary, and accuses it of violating the Employee Retirement Income Security Act of 1974. The Labor Department alleges UMR “simply denied” claims without assessing their merit. (Tepper, 8/1)

Bloomberg: What Health Insurance Companies Won’t Reveal About Your Medical Bills
Employers are losing trust in the companies they hire to run their health plans. Kraft Heinz Co. accused CVS Health Corp.’s Aetna of wasting its money by paying fraudulent medical claims. Two union health insurance plans in Connecticut alleged that insurer Elevance Health Inc. routinely overpaid medical bills. And the trustees of a bankrupt trucking company accused insurer UnitedHealth Group Inc. of mismanaging millions of dollars. (Tozzi, 8/2)

Modern Healthcare: Independent Hospitals Prices Increase Post-Acquisition: Study
Average inpatient prices for commercially insured patients rose 5% after health systems acquired an independent hospital, according to an analysis of commercial claims from 2012 to 2018 showing the prices hospitals negotiate with insurers. Readmission rates for patients receiving cardiac care at those hospitals increased by up to 12%, and remained elevated for three years after the acquisition, researchers found. The paper was published by the Public Policy Institute of Elevance Health, which operates Blue Cross Blue Shield plans. (Kacik, 8/1)

More health care industry developments —

AP: Amazon Adds Video Telemedicine Visits Nationwide To Its Virtual Clinic
Amazon is adding video telemedicine visits in all 50 states to a virtual clinic it launched last fall, as the e-commerce giant pushes deeper into care delivery. Amazon said Tuesday that customers can visit its virtual clinic around the clock through Amazon’s website or app. There, they can compare prices and response times before picking a telemedicine provider from several options. (Murphy, 8/1)

Stat: Microsoft Strikes Partnership With Duke Health To Advance Health AI
On Tuesday, Duke Health and Microsoft announced a five-year partnership that will support artificial intelligence applications in medicine, with a focus on building out infrastructure such as cloud-based data platforms. (Palmer, 8/1)

Becker’s Hospital Review: Another Big Health System Starts Billing For MyChart Messages
St. Louis-based BJC HealthCare has begun billing patients for MyChart messages, KMOV reported. The health system didn’t specify how much the messages will cost but noted the charges will apply to “complex interactions,” according to the July 24 story. … BJC joins a growing list of health systems that bill for MyChart messages as providers have experienced an explosion in patient portal traffic in recent years. However, hospital executives have differing opinions on the effectiveness of charging for the interactions. (Bruce, 8/1)

St. Louis Public Radio: SSM Health To Cut Trauma Care At DePaul Hospital In September
SSM Health will stop treating trauma patients at its hospital in Bridgeton next month, a move that will close the last care center of its type in north St. Louis County and send victims of gunshot wounds and other serious injuries to hospitals in St. Louis and Creve Coeur. As a state-designed Level II trauma center, SSM Health DePaul offers around-the-clock availability of surgeons and other specialists who can treat gunshot wounds, complications from car crashes and other serious injuries. The trauma designation will end Sept. 10, SSM officials said. (Fentem and Henderson, 8/1)

In news about health care workers —

San Francisco Chronicle: Doctors Sue California Medical Board To Halt Implicit Bias Training
A pair of doctors and a group that says it is determined to protect health care from “radical, divisive ideology” sued the Medical Board of California on Tuesday to stop it from enforcing a state law that requires doctors to study the role of implicit bias in treatment. The lawsuit filed in U.S. District Court in San Francisco targets a 2019 state law that describes implicit bias in health care as unconscious “attitudes or internalized stereotypes” that can lead to disparities in care among ethnic groups and by gender or sexuality even when medical complaints are similar. (Asimov, 8/1)

Stat: Physician Groups Backed By Private Equity Giant Lobby On Mergers
Three large and growing physician groups backed by the private equity giant Welsh, Carson, Anderson & Stowe have hired a prominent lobbying firm to influence federal policy covering mergers and acquisitions. Over the past two weeks, United Musculoskeletal Partners, U.S. Anesthesia Partners, and U.S. Radiology Specialists each registered with Forbes Tate Partners, a lobbying shop founded by political insiders who used to work in President Bill Clinton’s administration. (Herman, 8/1)

NBC News: CEO Of HCA Hospital In Florida That Allegedly Had Roaches In The Operating Room Leaves Job
The chief executive of HCA Florida Bayonet Point, the Hudson, Florida, hospital whose physicians characterized it as unsafe and unclean in a February NBC News report, has departed after less than four years, according to a memo delivered to the staff Friday. Regina Temple is leaving “to pursue other opportunities outside HCA Healthcare, effective immediately,” the memo said. Temple’s exit seemed sudden, physicians working at the hospital said, as she was engaged in long-term initiatives as recently as mid-July. (Morgenson, 8/1)

Kansas City Star: Beloved Doctor Gunned Down At Park: North Carolina Police
A beloved doctor and mom was gunned down at a North Carolina park in the middle of the afternoon, officials said. Dr. Gwendolyn Lavonne Riddick, who worked as an OB/GYN, was found shot multiple times next to her Ford Mustang. The 40-year-old was rushed to UNC Health Rockingham hospital, where she died Sunday, July 30, according to her former employer and the Eden Police Department. (Jasper, 8/1)

Stat: Verily Hires Former Apple Health Leader As Chief Scientific Officer
As Verily aims to get on track, the Alphabet life science company has hired Andrew Trister, an oncologist and veteran of big technology companies and research, as its new chief scientific officer. (Aguilar, 8/1)

Also —

Becker’s Hospital Review: Black Med Students 50% More Likely To Leave MD Training, Study Finds
Half of Black medical students pursuing an MD degree leave before finishing — an attrition rate that is significantly higher than that of their peers, research published July 31 in JAMA found. … Between the 2004 and 2012 study timeframe, only 17 percent of White MD students did not finish their training compared to 29 percent of Black students. (Hollowell, 8/1)