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UnitedHealthcare

Behind-the-Scenes Audits Often Hide Cause of Test Claim Denials

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How Private Health Insurers May Respond to FDA LDT Regulation

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Significant Developments Are Shaping Lab Market

CEO SUMMARY: With 140 speakers and 1,000+ attendees, this year’s Executive War College again provided a comprehensive picture of the specific forces reshaping the U.S. market for lab testing services. Presented here is a smorgasbord of information and innovation shared by different spea…

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Change Health Cyberattack Breaches PHI Here at TDR!

CEO SUMMARY: It was Feb. 21 when cybercriminals attacked Change Healthcare’s claims processing systems. On April 22, UnitedHealth Group issued a statement that PHI for “a substantial proportion of people in America” was breached. We believe the PHI of our employees and T…

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UnitedHealth Group Faces DOJ Antitrust Probe

CEO SUMMARY: Recent events have not been kind to UnitedHealth Group and its subsidiaries UnitedHealthcare and Optum. In February, just as UHG’s Change Healthcare division was hit with a major cyberattack that disrupted billions of dolla…

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Walgreens to Close 60 VillageMD Locations

CEO SUMMARY: Following substantial losses in fiscal 2023, Walgreens is working to cut costs and reduce overhead. One casualty in this effort will be the closure of 60 of the 360 primary care clinics in retail pharmacy stores built by Walgreens in recent years. These actions demonstrate th…

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Labs Should Prepare for Arrival of ‘Perfect Storm’

CEO SUMMARY: In the near future, clinical labs and pathology groups will need to address three major developments. One involves the FDA proposed LDT rule. A second is the adoption by payers of guidelines that require genetic test claims to have Z-Codes. The third centers around coming ref…

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CMS Issues AI Guidance for Medicare Advantage

CEO SUMMARY: With its guidance on how Medicare Advantage plans should use artificial intelligence (AI) when making treatment decisions involving individual patients, the federal Centers for Medicare and Medicaid Services has opened one door in the coming debate on how the federal governme…

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Year’s Top 10 Lab Stories Contain Surprises & Twists

CEO SUMMARY: With the SARS-CoV-2 pandemic now in the rearview mirror of the nation’s clinical labs and pathology groups, the important news stories of 2023 were mostly about developments where the consequences will influence laboratory operations in coming years. Artificial intelligence…

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Why Payers Bristle as Labs Submit Inpatient Fees for Outreach Tests

        EDITOR’S NOTE: Our column, Virchow, is written…

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