Several major health plans have recently enacted policies regarding coverage status for Remicade (infliximab) and its biosimilars, Inflectra (infliximab-dyyb) and Renflexis (infliximab-abda). Most of these plans are limiting coverage for the biosimilar products to very specific circumstances. Some have also begun denying claims for biosimilars and instructing patients to switch to Remicade. The plans implementing…
U.S. Accuses UnitedHealth of Medicare Advantage Fraud
(Reuters)—The U.S. Justice Department (DOJ) has accused UnitedHealth Group Inc. of obtaining inflated payments from the government based on inaccurate information about the health status of patients enrolled in its largest Medicare Advantage Plan.1 The complaint, filed in federal court in Los Angeles on Monday, came after the DOJ earlier this year intervened in two…
UnitedHealth Sued by U.S. Over Medicare Charges
(Reuters) – The U.S. Department of Justice (DOJ) has joined a whistleblower lawsuit against UnitedHealth Group Inc. that claims the country’s largest health insurer and its units and affiliates overcharged Medicare hundreds of millions of dollars, a law firm representing the whistleblower said on Thursday. “We reject these more than five-year-old claims and will contest…
UnitedHealth Group to Require MRI Accreditation
Starting March 1, 2008, UnitedHealth Group will require all freestanding facilities and physician offices that perform MRIs and certain other imaging studies to obtain accreditation. Physicians without accreditation will not be reimbursed for the technical or global codes. UnitedHealth Group is the umbrella organization for insurance companies such as United Healthcare, Ovations, and AmeriChoice.