Aetna, Elevance, Humana Medicare marketing lawsuit moves forward The Medicare Advantage insurers face allegations they paid kickbacks to online brokerages for signing up healthy Medicare beneficiaries.

Aetna, Elevance, Humana Medicare marketing lawsuit moves forward. Commercial insurers are theives and scammers. www.modernhealthcare.com/insurance/mh...
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#consulting #healthcare #physicians #compliance #business

David Zetter on Evaluating Insurance Companies and Plans If you take health insurance as payment, then choosing good payers makes sense. How do you figure out which payers to contract with? It’s a logical question that has a very involved, sometimes not so…

David Zetter on Evaluating Insurance Companies and Plans – MARKETVISORY GROUP buff.ly/CQDnnqZhttps... #practicemanagement #medicalbilling #credentialing #zetterhealthcare #consulting #healthcare #physicians #compliance #business #healthcareconsulting #CHBC #practicestartups #revenuecyclemanagement

Implementing Proactive Revenue Cycle Policies and Procedures: Stop Chasing Money. buff.ly/HMPpByM
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#consulting #healthcare #physicians #business #healthcareconsulting #CHBC #practicestartups #revenuecyclemanagement

CMS finalizes 2.6% outpatient pay bump, site-neutral policies Hospitals lambasted the final rule as inadequate, arguing the sector is facing significant financial pressures.

Finally!! Site-neutral policies, inpatient only list
ts for patients and Medicare.  tinyurl.com/4ntubunb

Republicans are racing to find a plan for enhanced ACA subsidies. Here’s what they are considering | CNN Politics With less than six weeks before a key set of Affordable Care Act premium subsidies expire, congressional Republicans are scrambling to come up with a plan to address the pain of health care premiums…

Republicans are racing to find a plan for enhanced ACA subsidies. Here’s what they are considering | CNN Politics www.cnn.com/2025/11/18/p...
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#consulting #healthcare #physicians #compliance #business

UnitedHealth to stop covering most remote patient monitoring The health insurance giant will end coverage of remote patient monitoring services for most chronic conditions next year.

UnitedHealth to stop covering most remote patient monitoring www.modernhealthcare.com/insurance/mh...
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#consulting #healthcare #physicians #compliance #business #healthcareconsulting #CHBC #practicestartups

Elevance to penalize facilities for out-of-network providers Elevance Health aims to cut down on out-of-network claims.

Elevance to penalize facilities for out-of-network providers www.modernhealthcare.com/insurance/mh...

Emergency department deaths tick up following private equity acquisition: study Patients may be more likely to die in private equity-owned emergency departments than other similar facilities, according to a study published Tuesday in the Annals of Internal Medicine.

PE DOES NOT BELONG IN HEALTHCARE! Emergency department deaths tick up following private equity acquisition: study www.healthcaredive.com/news/emergen...

David Zetter on Holding Payors Accountable If you take health insurance as payment, payers are a big part of your practice. What happens when they mess up? How do you hold them accountable? Can you hold them accountable? My guest today says…

David Zetter on Holding Payors Accountable – MARKETVISORY GROUP marketvisorygroup.com/podcast/davi...
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Medicare Advantage risk adjustment 'a failing system': Report - Becker's Payer Issues | Payer News A group representing nonprofit health plans is raising concerns over what it claims is a wide variation in Medicare Advantage risk adjustment scores across insurers, leading to what it calls a…

Medicare Advantage Risk Adjustment Failure!! www.beckerspayer.com/payer/medica... zetter.com #practicemanagement #medicalbilling #credentialing #zetterhealthcare
#consulting #healthcare #physicians #compliance #business #healthcareconsulting #CHBC #practicestartups #revenuecyclemanagement

UnitedHealthcare, Humana are gaming Medicare Advantage risk adjustment, analysis finds The research from the Alliance for Community Health Plans adds to existing evidence that major insurers are unfairly profiting from MA’s risk adjustment system, driving billions of dollars in…

More thieves are stealing from the Medicare Trust Fund. This has to stop! www.healthcaredive.com/news/unitedh... zetter.com #practicemanagement #medicalbilling #credentialing #zetterhealthcare
#consulting #healthcare #physicians #compliance #business #healthcareconsulting #CHBC #practicestartups

Interviewed by the great Leslie Kane! When to Sell Your Medical Practice to a Private Equity Firm or Hospital www.medcentral.com/biz-policy/p...
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#consulting #healthcare #physicians #compliance #business

Centene joins other insurers facing 'ghost-network' allegations "Ghost-network" lawsuits allege insurance companies list providers in their directories who are deceased, retired or otherwise unavailable.

Do payors do anything legally? Centene joins other insurers facing 'ghost-network' allegations www.modernhealthcare.com/insurance/ce...
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#consulting #healthcare #physicians #compliance #business #healthcareconsulting

Judge rejects bid to dismiss MultiPlan antitrust complaints The data analytics firm, now operating as Claritev, sought dismissal of the claims in two ongoing lawsuits.

The illegal activities by payors are never-ending. Judge rejects bid to dismiss MultiPlan antitrust complaints www.modernhealthcare.com/legal/clarit...
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#consulting #healthcare #physicians #compliance #business

Thank you to Leslie Kane for the interview! When to Sell Your Medical Practice to a Private Equity Firm or Hospital www.medcentral.com/biz-policy/p...
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#consulting #healthcare #physicians #compliance #business

UnitedHealth Group faces lawsuit claiming it used ex-employees' 401(k) funds to defray its own costs It’s the latest in a surge of lawsuits for the beleaguered health care giant, and the company has denied the allegations.

Isn't it time for UHC to held accountable? UnitedHealth Group faces lawsuit claiming it used ex-employees' 401(k) funds to defray its own costs fortune.com/article/unit...
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UnitedHealth Group Incorporated (UNH) Faces Mounting Backlash Amid Billing Disputes, CEO Resignation, and Criminal Probe UnitedHealth Group Incorporated (NYSE:UNH)’s UnitedHealthcare, the largest private health insurer in the U.S., is facing unprecedented public and regulatory scrutiny amid mounting patient frustration…

What a joke of an insurer. UnitedHealth Group Incorporated (UNH) Faces Mounting Backlash Amid Billing Disputes, CEO Resignation, and Criminal Probe finance.yahoo.com/news/unitedh...
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#consulting #healthcare #physicians

Insurance Company Accused of Pressuring Medical Staff to Change Patients' Status to "Do Not Resuscitate" Practitioners say that UnitedHealth pressed them to change patients' status to "do not resuscitate," The Guardian reports.

Could be worst ins co in US. Insurance Company Accused of Pressuring Medical Staff to Change Patients' Status to "Do Not Resuscitate" futurism.com/neoscope/uni...
zetter.com #practicemanagement #medicalbilling #credentialing#zetterhealthcare #consulting #healthcare #physicians #compliance #business

UnitedHealth under criminal probe for possible Medicare fraud, WSJ reports UnitedHealth said it had not been notified by the DOJ about the "supposed criminal investigation reported," and the company stood by "the integrity of our Medicare Advantage program." The health…

More shenanigans. Insurers are thieves. UnitedHealth under criminal probe for possible Medicare fraud, WSJ reports finance.yahoo.com/news/unitedh...
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#consulting #healthcare #physicians #compliance #business

Site-neutral Medicare pay eyed to fund Trump tax cuts Republicans eager to offset the cost of cutting taxes may see lower Medicare spending on outpatient care as a source of budgetary savings.

Site-neutral Medicare pay eyed to fund Trump tax cuts. About time to remove this payment to hospitals. www.modernhealthcare.com/politics-pol...
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#consulting #healthcare #physicians #compliance #business

Cigna to spend $150M to improve prior auth, patient advocacy: CEO Cigna Group CEO David Cordani said the company will make investments this year to improve patient and provider experiences with the insurer.

I will believe it when I see it. Cigna to spend $150M to improve prior auth, patient advocacy: CEO https://buff.ly/4aEbORnhttps://zetter.com #practicemanagement #medicalbilling #credentialing #zetterhealthcare
#consulting #healthcare #physicians #compliance #business #healthcareconsulting #CHBC

Were you aware that there are a plethora of state and federal laws that dictate what a managed care organization can and cannot do with your claims, your enrollment, etc. If you, your credentialing and billing team do not know these laws, then you are being ripped off every day of the week.

Republicans outline trillions in healthcare cuts House Republicans have a long list of health policies in mind for 2025, including taxation of nonprofit hospitals and massive Medicaid cuts.

Republicans outline trillions in healthcare cuts https://buff.ly/3PEvZ8c
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UnitedHealth agrees to $69M settlement in lawsuit over 401(k) plan UnitedHealth Group has agreed to pay $69 million to settle a class-action lawsuit that alleged the company put its business relationship with Wells Fargo ahead of information the company's 401(k)…

You cannot make this stuff up. What a screwed-up organization. They even cheat and steal from their employees. UnitedHealth agrees to $69M settlement in lawsuit over 401(k) plan https://buff.ly/3VJWKvw
https://zetter.com #practicemanagement #medicalbilling #credentialing #zetterhealthcare

Exclusive | UnitedHealthcare CEO fatally shot outside of Hilton hotel in Midtown in possible targeted attack: sources The CEO of UnitedHealth was fatally shot in the chest Wednesday morning outside the Hilton hotel in Midtown in what police say was a targeted attack.

Exclusive | UnitedHealthcare CEO fatally shot outside of Hilton hotel in Midtown in possible targeted attack: sources https://buff.ly/4eZWSxE
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#consulting #healthcare #physicians #compliance #business

Cybersecurity in healthcare: How hackers get in and how organizations can protect themselves A cybersecurity expert explains why healthcare organizations are vulnerable to cyberattacks — and how they can strengthen their defenses.

Cybersecurity in healthcare: How hackers get in and how organizations can protect themselves https://buff.ly/48yM73B
https://zetter.com #practicemanagement #medicalbilling #credentialing #zetterhealthcare #consulting #healthcare #physicians #compliance #business #healthcareconsulting

Senate report slams Medicare Advantage insurers for using predictive technology to deny claims UnitedHealth, CVS and Humana used technology to increase MA prior authorization denials for post-acute services, boosting profits, according to a report from a Senate subcommittee.

Just another scam. Senate report slams Medicare Advantage insurers for using predictive technology to deny claims https://buff.ly/4eagHC6
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#consulting #healthcare #physicians #business #healthcareconsulting

Insurers lie, cheat, and steal from you every day. I will be posting facts and examples of this in the coming weeks. It is time to take these thieves down. Stop the madness Ex: compare your claim to your EOB and our ERA. Do they match?
https://zetter.com #practicemanagement #medicalbilling

CVS ousts Karen Lynch, taps Caremark head as new CEO https://buff.ly/3A5NnPa
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#consulting #healthcare #physicians #compliance #business #healthcareconsulting #CHBC #practicestartups #revenuecyclemanagement

Errors in Deloitte-Run Medicaid Systems Can Cost Millions and Take Years To Fix - KFF Health News As states wait for Deloitte to make fixes in computer systems, Medicaid beneficiaries risk losing access to health care and food.

Incompetence. Corps contributing to the disaster that is US Healthcare. Errors in Deloitte-Run Medicaid Systems Can Cost Millions and Take Years To Fix - KFF Health News https://buff.ly/47kVQu2
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