(Reuters)—The U.S. Department of Justice has significant concerns about Aetna Inc.’s proposed acquisition of health insurer Humana Inc., a source familiar with the situation said on Thursday, and shares of Humana fell more than 11%. Aetna’s purchase of Humana would combine two of the largest providers of Medicare Advantage plans for elderly people, and investors…
California Insurance Commissioner Urges U.S. to Block Anthem-Cigna Deal
(Reuters)—California’s insurance commissioner on Thursday urged the U.S. Department of Justice (DOJ) to block health insurer Anthem Inc.’s acquisition of Cigna Corp., saying he is concerned it will raise premiums in the state. Dave Jones, who as insurance commissioner in California does not have authority to approve the deal, says he believes his recommendation will…
Doubts Mount over Merger of Health Insurers Anthem, Cigna
(Reuters)—Wall Street expressed growing doubts about a pending $54 billion merger of U.S. health insurers Anthem Inc. and Cigna Corp. on Monday as news of management squabbles added to concerns over its review by antitrust regulators. Cigna shares closed down 4% at $126.15, well below Anthem’s original $188 per share offer of cash and stock…
Preparing for Increased HIPAA Audits Among Smaller Rheumatology Providers
Recent enforcement activities of the Department of Health and Human Services’ Office for Civil Rights (OCR) have shown an increase in fines and penalties assessed against smaller providers for failing to comply with the privacy, security and breach notification requirements of the Health Insurance Portability and Accountability Act (HIPAA). Historically, OCR has focused on larger…
What Rheumatologists Need to Know about Payer Audits
Both government and private payers continue to aggressively monitor providers to prevent and recover overpayments. This is evidenced by the fact that the number of audits conducted in recent years has increased dramatically. A negative audit finding can result in the need to repay five- or seven-figure amounts. Types of Audits Private Payer Audits Private…
U.S. Hospital Group Warns of Blue Cross Dominance if Anthem Buys Cigna
(Reuters)—The American Hospital Association warned U.S. antitrust regulators that Anthem Inc.’s proposed acquisition of Cigna Corp. will hurt other health insurers’ ability to compete with Blue Cross Blue Shield plans, leading to higher premiums for consumers. Anthem, the country’s second-largest health insurer, runs Blue Cross Blue Shield plans in 14 states. The hospital group, in…
Los Angeles Hospital Paid Hackers $17,000 Ransom in Bitcoins
(Reuters)—The president of Hollywood Presbyterian Medical Center said on Wednesday that his hospital paid hackers a ransom of $17,000 in bitcoins to regain control of their computer systems after a cyber attack. Allen Stefanek said in a statement that paying the ransom was the “quickest and most efficient way” of regaining access to the affected…
Pfizer Unit to Pay $784.6 Million in Medicaid Rebate Settlement
(Reuters)—Pfizer Inc. said its Wyeth unit has agreed to pay $784.6 million to settle cases related to the calculation of Medicaid rebates for a gastric drug between 2001 and 2006. The claims alleged that Wyeth’s calculation of rebates for its proton pump inhibitor Protonix (pantoprazole) violated the Federal Civil False Claims Act and other laws…
Hospital Acquisitions of Physician Practices Likely to Decrease
On Nov. 2, 2015, President Barack Obama signed the Bipartisan Budget Act of 2015 (the Act) into law. This critical piece of legislation raises the federal debt ceiling and provides the framework for the federal budget through 2017. Of particular importance, the Act significantly changes the way Medicare will reimburse hospitals for outpatient services furnished…
U.S. Appeals Court: Hospitals Can Be ‘Urban’ & ‘Rural’ at Same Time
NEW YORK (Reuters)—The federal appeals court in New York struck down a U.S. regulation that made it harder for hospitals to provide better medical care at lower cost by claiming they were “rural” for some purposes and “urban” for others. Thursday’s decision by the Second U.S. Circuit Court of Appeals is a victory for hospitals…
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