MultiCare Agrees To Settle Claims That It Permitted Unnecessary Surgeries
The health system settled with the federal government and Washington state over spinal surgery procedures at its facilities between 2019 and 2021. Other health industry news is on Molina, UnitedHealthcare, Aetna, Epic, and more.
Fierce Healthcare:
MultiCare Pays $3.7M To Settle Unnecessary Surgery Allegations
MultiCare Health System has agreed to a multimillion-dollar settlement with law enforcement to resolve allegations it ignored “numerous red flags” and knowingly permitted and billed procedures conducted by a neurosurgeon under investigation for fraudulent, medically unnecessary care. (Muoio, 2/6)
More from the health insurance industry —
Modern Healthcare:
Molina Eyes Medicaid Acquisitions Amid Medicare Advantage Exit
Molina Healthcare is looking to acquire Medicaid carriers as it exits the Medicare Advantage market. State reimbursements have fallen short of Medicaid members’ expenses, CEO Joe Zubretsky told analysts during the company’s fourth-quarter earnings call Friday. The challenging funding environment, however, presents an opportunity to buy smaller insurers that lack the capital to tough out the difficult cycle, Zubretsky said. (Tepper, 2/6)
Modern Healthcare:
UnitedHealthcare Leads In Medicare Advantage Prior Auth Denials
Medicare Advantage insurers processed 52.8 million prior authorization requests in 2024, a 6% increase from the prior year and 42.3% more than in 2019, according to an analysis by the health policy research group KFF. These health insurance companies at least partly denied 7.7% of prior authorization requests in 2024, up from 6.4% in 2023, the review of Centers for Medicare and Medicaid Services data found. The number of requests per Medicare Advantage member declined slightly to 1.7 in 2024. (Tepper, 2/5)
Stat:
Updated CMS Data Reshapes Medicare Advantage Risk Scores
The health insurance industry was caught off guard by the federal government’s recent proposal to keep next year’s payments to Medicare Advantage plans mostly flat, and to change a controversial coding practice. But another equally significant change has flown under the radar — and is a major reason why some insurers may face big hits to revenue. (Herman, 2/9)
Fierce Healthcare:
Aetna Rolls Out New Digital Member Onboarding Experience
Aetna is continuing to build out its digital member experience with the launch of a new onboarding program designed to ease the process. The insurer said Thursday that the platform will be available to 4 million new members during the welcome period for their enrollment. (Minemyer, 2/6)
Also —
Modern Healthcare:
Epic Systems Launches AI Charting Tool In Latest EHR Market Push
Epic Systems made another move earlier this week to advance its artificial intelligence strategy. The large electronic health record vendor hosted an event for its customers on Wednesday, where it officially launched its AI charting tool. The customizable ambient listening feature aims to help clinicians write notes and offers guidance based on these conversations. The feature is an expansion of Art, Epic’s suite of AI for clinicians that it announced in August at the company’s user group meeting. The AI charting tool is available to customers immediately. Group Health Cooperative of South Central Wisconsin, is among the early adopters. (Famakinwa, 2/6)
The Baltimore Sun:
Johns Hopkins University Research Staff Begin Unionization Effort
Johns Hopkins University research staff announced plans this week to start a union in an effort to get higher pay, transparent career paths and more job security. (Bazos, 2/4)
KFF Health News:
This Ballad Hospital, Flooded By Hurricane Helene, Will Be Rebuilt For $44M In A Flood Plain
A small Tennessee hospital that was destroyed by a surging river during Hurricane Helene will soon be rebuilt on low-lying farmland that could face several feet of flooding in a much smaller storm, risking another disaster if the new facility is not built to withstand extreme weather, according to a KFF Health News analysis. (Kelman, 2/9)
