Latest news with #Novitas
Telegraph
2 days ago
- Business
- Telegraph
‘A loan to fund my divorce left me homeless and £300k in debt'
Shelley Kavanagh knew getting divorced would be expensive. But she never imagined it would leave her homeless and saddled with a six-figure debt. The 55-year-old mother-of-three went from living in a seven-bedroom house to struggling to rent a flat after taking out a loan to fund her legal costs. She said: 'By the time everything unravelled, the combined loan and legal costs had far exceeded my assets, leaving me financially ruined.' The Telegraph has spoken to several women who were advised by their solicitors to fund their divorces using huge loans that devastated their finances. The loans – provided by litigation funders – were borrowed against the marital home so they could only be repaid following the sale of the property. Until then interest piled up at a rate of 18pc. This eye-watering level of interest meant that by the time the women came to sell up, the debt had eroded the equity in their homes. Campaigners are now calling for tighter regulation of lenders trying to cash in on divorce. 'It had a direct impact on my children' Ms Kavanagh's ordeal began when she was introduced to Novitas, one of the best-known divorce lenders, in 2015 by her solicitors. A housewife at the time, she agreed to borrow £150,000 to finance her divorce. The initial interest rate was 18pc – adding £27,000 in the first year, not including other charges. By the time the divorce was over, the debt had ballooned to over £300,000. She said: 'My credit rating was destroyed, and I became homeless. This had a direct impact on my children, as my unstable housing situation meant overnight stays with me were nearly impossible. Even finding a rental property became a challenge, as landlords were reluctant to accept tenants with poor credit histories.' Ms Kavanagh, who now lives in Oxfordshire, had to move in with her father while she got back on her feet. She was only able to find accommodation after he lent her money to pay the rent in advance. She said: 'Without that support, the outcome would have been significantly different.' The Novitas loan was paid using the proceeds of the house sale, leaving Ms Kavanagh 'with very little remaining'. The lender agreed to a £50,000 reduction after she complained. But she still believes the company should not have lent to her in the first place. 'Targeted at the height of vulnerability' Launched in 2011, Novitas at one point described itself as the leading provider of loans for people going through divorce. It claimed to work with 900 law firms, according to a post on the platform Twitter, now X, from 2019. Documents show Novitas would carry out a credit check as part of an individual's application. It said it was 'unlikely' to lend if the applicant had a County Court Judgement (CCJ). Ms Kavanagh had a CCJ – yet she was lent the money anyway. She said: 'A CCJ is a clear warning sign of financial vulnerability, yet Novitas proceeded with the loan regardless. This suggests that they either failed to conduct proper credit checks or deliberately ignored red flags.' She said women like her had been presented with the loans while they were at 'the height of their vulnerability'. She added: 'We want justice for what we've been through.' 'My divorce debt snowballed to £700,000' The litigation funding industry has grown dramatically over the past decade, filling a vacuum left behind by cuts to legal aid. Lenders argue they give important financial backing to individuals pursuing fair divorce settlements. However, in recent years a number of borrowers have lodged complaints about litigation loans with the Financial Ombudsman Service (FOS), some of which have been upheld. Another mother introduced to Novitas by her solicitor was Rosie Heys. In 2014, Ms Heys, 59, from Oxfordshire, agreed to borrow £100,000 to cover her divorce costs. Again, this loan, which carried an 18pc interest rate, was secured against her property. At the time, she only earned about £1,000 a month working as a freelance personal assistant – although the stress of the divorce meant she eventually lost the job. As the case dragged on, Ms Heys agreed to take out additional borrowing, taking her total debt to £230,000. She instructed a different solicitor and took out a personal loan with a lower interest rate from another provider. This was used to pay the new fees and the Novitas loan. She said: 'I couldn't see a way out. I was stuck in a house I couldn't sell, with a debt that was accruing at £600 a day. I just didn't know what to do.' It took Ms Heys a decade to sell the property, with £700,000 of the proceeds used to pay off the loan. Ms Heys complained to Novitas who agreed to refund her £7,000 in interest because it had failed to provide her with regular statements about her debt. However, it did not accept her other complaints and so Ms Heys approached the FOS, which concluded in 2023 that the loan was unaffordable and that Novitas had not carried out adequate affordability checks. It ordered Novitas to refund the interest and charges, which added up to £50,000 in total, but not the capital, as this had been used to cover the solicitors' fees. In a separate case, involving a woman who borrowed £45,000, the FOS went further and instructed Novitas to refund almost her entire debt. The lender was told to cap her liability at £1,745 as this was the amount the FOS decided she might reasonably have spent on mediation. 'I wish I'd walked away and let my husband take everything' Ms Heys and Ms Kavanagh have spoken to dozens of women who also took out litigation loans that significantly impacted their finances and mental health. One mother, who asked to remain anonymous, told The Telegraph she wished she had just walked away and left her ex-husband everything rather than get divorced because at least then she would not be in debt. Ms Heys said: 'Some people are so traumatised that they just can't handle it.' She said the debt had also had a profound impact on the children of the women affected, as many were now living in rental accommodation. 'Renting in this country is very precarious because people can give you notice and get you out in two months. And that's the situation most of these children have found themselves in.' Ms Heys and Ms Kavanagh want those affected to know they may be able to seek redress through the FOS. But they also want greater awareness of the risks of litigation loans for those going through a divorce. Former MP Seema Kennedy, of campaign group Fair Civil Justice, said: 'These appalling cases highlight the urgent need for reform. Vulnerable individuals going through divorce should not be exploited by litigation funders with clear conflicts of interest, racking up excessive fees that can reach hundreds of thousands of pounds. Without proper regulation, consumers are left dangerously exposed.' Litigation loans are regulated under the Consumer Credit Act 1974. But they are also part of the broader third-party litigation funding industry, which is largely self-regulated. Other agreements are 'non-recourse', meaning the litigation funder only gets paid if the case is successful. The Civil Justice Council this week called for 'light-touch regulation' of litigation funding following a consultation. In a report, it said complaints about litigation loans with the FOS reinforced the need 'for effective financial services and legal services regulation' and highlighted the need for consumers to be 'fully informed' about the nature of this funding. Novitas was bought by Close Brothers in 2017 in a £31m deal. However, it ceased lending to new customers in 2021 and is now in the process of being wound down. The banking group had to set aside over £100m to cover its bad loans. In its 2022 accounts, Novitas earmarked £5.3m in redress for customers who took out loans to fund divorce and probate cases.
Scoop
29-04-2025
- Health
- Scoop
Triage Plus Price Set To Lift Pacific Edge's Economics
Pacific Edge notes today that the draft 'Gapfill' prices for Cxbladder Triage Plus2 have been published by the US Centers for Medicare & Medicaid Services (CMS) proposing a draft price for the test of US$1,018.44. When finalized, the CMS price for Triage Plus sets the amount Pacific Edge will be reimbursed for all patients with Medicare and Medicare Advantage insurance. This will be subject to Pacific Edge's Medicare Administrative Contractor (MAC), Novitas, providing coverage of the test. The test is currently listed as non-covered on Novitas' 'Genetic Testing in Oncology: Specific Tests (L39365)' Local Coverage Determination (LCD). Private health insurance companies make separate coverage and pricing decisions based on their own medical policy and contracting for a test. In the Gapfill process CMS asks each MAC to propose prices for any new testing services based on estimates of the resources needed to develop and run the test, then recommends the median of those prices as its final price. The seven MACs responsible for processing Medicare claims across various jurisdictions in the United States have published their draft pricing for Triage Plus. While Novitas priced Triage Plus at US$1,587.69, due to its agreements with multiple MACs, the price provided by MolDX3 is the de facto median price, because MolDX pricing is used in 28 of the 50 states. The draft pricing for MolDX was US$1,018.44, and subject to public comments that are due by 28 June 2025, and some possible adjustment based on those comments, CMS is expected to make that price effective on 1 January 2026. Hematuria evaluation tests currently represent around 81% of Pacific Edge's total US laboratory throughput4. The US$1,018.44 price is a meaningful increase compared to the US$760 CMS price of our existing tests, because it increases the margin and margin percentage per test and improves the profitability of operating our front-line sales force. When coverage of Triage Plus is established, Pacific Edge will make migration from Triage a priority, noting that Detect tests are being migrated to Triage tests effective immediately given the February 2025 inclusion of Triage in the American Urological Association's microhematuria guideline. Pacific Edge expects to submit a reconsideration request for coverage of Triage Plus as soon as the analytical validation (AV) and clinical validation (CV) studies have been published. The AV publication is being reviewed by the submitting authors and the CV publication, the DRIVE study5, has already been submitted for publication. Pacific Edge Chief Executive Dr Peter Meintjes said: 'We are very pleased that both MolDX and Novitas have recognized the novelty of Triage Plus in their pricing determinations with prices of US$1,018.44 and US$1,587.69 respectively. We have invested significant resources in Triage Plus – a multimodal test that combines DNA and RNA workflows with the outputs analyzed by a novel algorithm that provides dramatic performance improvement over existing tests and can be used on a broader patient population to assist clinicians to manage their hematuria patients as high, intermediate or low risk. 'The resources needed to develop, validate and operate Triage Plus commercially are substantial, thus necessitating a higher price, but importantly when Triage Plus' performance characteristics6 are used in our existing budget impact model7 we observe that the improved performance characteristics has the potential for even greater savings to the Medicare system by reducing more unnecessary procedures and allowing clinicians to spend more time and clinical resources on those who need it most.' Notes: 1 PEB has released the information contained in this update to the NZX and ASX as it regards it to be material, as defined in the NZX Listing Rules and Section 231 of the FMC Act. 2 Cxbladder Triage Plus has CPT Code 0420U and has not yet completed the administrative name change from Cxbladder Detect+. 3 MolDX is a coverage and reimbursement program run by the Palmetto MAC that provides unique test registrations and technical assessments for molecular diagnostics products to which other MACs can subscribe. The majority of MACs have elected to do so, but Novitas and National Government Services do not. 4 Half year to 30 September 2024. 5 Detection and Risk stratification In Veterans presenting with hematuria: Savage S.J., et al (2025) The Prognostic Performance of Cxbladder Triage Plus for the Identification and Priority Evaluation of Veterans at Risk for Urothelial Carcinoma: The Drive Study, Abstract submitted to the AUA 2025 meeting. 6 Lotan Y, Raman JD, Konety B, Daneshmand S, Schroeck F, Shariat SF, Black P, de Lange M, Asroff S, Goldfischer E, Efros M, Chong KT, Huang E, Chua HL, Wu QH, Yeow S, Lau W, Yong J, Eng M. Urinary Analysis of FGFR3 and TERT Gene Mutations Enhances Performance of Cxbladder Tests and Improves Patient Risk Stratification. J Urol. 2022 Dec 30:101097 JU0000000000003126. 7 Tyson MD, Abouassaly R, Durant A, Smith AB, Seemann K, Shoskes DA. Budgetary Impact of Including the Urinary Genomic Marker Cxbladder Detect in the Evaluation of Microhematuria Patients. Urol Pract. 2024 Jan;11(1):54-60. doi: 10.1097/UPJ.0000000000000489. Epub 2023 Nov 1. PMID: 37914255.
Scoop
28-04-2025
- Health
- Scoop
Medicare LCD Effective; Pacific Edge Seeks Recoverage
Press Release – Pacific Edge Pacific Edge filed for a preliminary injunction and undertook political advocacy efforts directed at the incoming political appointees within CMS2, HHS3 and OGC4 that included substantial support from the American Urological Association (AUA). Pacific Edge notes the 'Genetic Testing in Oncology: Specific Tests' (L39365) Local Coverage Determination became effective on 24 April 2025 in the US, halting Medicare coverage of Cxbladder tests. Pacific Edge filed for a preliminary injunction and undertook political advocacy efforts directed at the incoming political appointees within CMS2, HHS3 and OGC4 that included substantial support from the American Urological Association (AUA). However, on Wednesday 23 April 2025 a Pennsylvania District Court Judge ruled that her court lacks jurisdiction to hear Pacific Edge's claim against Medicare Administrative Contractor Novitas and CMS. Meanwhile, the lobbying efforts have not yielded a change to the effective date or retirement of the LCD. Pacific Edge, which currently generates ~60% of its US revenue from Medicare, will now focus on the paths available, which include Medicare appeals for Cxbladder Triage to get paid based on its inclusion in the AUA microhematuria guideline5, despite the non-coverage determination and reconsideration requests for Triage and Monitor. Pacific Edge submitted a reconsideration request for Cxbladder Triage under 'Biomarkers for Oncology' LCD (L35396) on 21 March 2025, a request that has already been deemed valid by Novitas, meaning they will now assess the evidence submitted. It also expects to submit a reconsideration request for Cxbladder Monitor under 'Genetic Testing in Oncology: Specific Tests' (L39365) as soon as possible and request non-coverage to be removed. However, Pacific Edge will not seek re-coverage of Cxbladder Detect as no new evidence has been published that can be submitted for reconsideration. Detect users will be required to move over to Triage in an acceleration of a plan intended to coincide with the commercial launch of Triage Plus. Novitas controls the timeline for these reconsideration requests and is not bound by any maximum period to complete this work. Industry experts typically estimate the time at 6-9 months for a valid submission of a single product with only a small number of new supporting publications and not the protracted period of consultation that results from creating a new LCD as was done with L39365. Regarding Cxbladder Triage Plus, the company will continue to develop, publish and subsequently submit a reconsideration request in line with our previously published roadmap – those activities remain on track. The company will also continue to work with Kaiser Permanente on a peer-reviewed publication confirming the real-world utility of Cxbladder Triage. The preliminary data was presented as a poster at the AUA 2025 annual meeting (April 26–29) in Las Vegas and will be used for future reconsideration requests when published. While the impact of 'Genetic Testing for Oncology: Specific Tests' (L39365) is expected to have a significant impact on testing volume, Pacific Edge expects to continue to bill and receive reimbursement from contracted commercial US payers without interruption, notably Kaiser Permanente, the US Veterans Administration, various Blue Cross Blue Shield plans under the group purchasing agreement and from non-contracted private payers in line with historic reimbursement rates. Similarly, Pacific Edge expects collections from our enhanced patient responsibility and patient assistance programs to continue in line with the rates since the introduction of that program in July 2023. Pacific Edge Chief Executive Dr Peter Meintjes said: 'This finalization is a poor outcome for Medicare patients and urologists, as it removes coverage for guideline-recommended testing and followed a flawed process that failed to review the most-current evidence. 'We are obviously disappointed we have been unable to maintain coverage of our tests in the short term. However, as we noted when the final LCD was published in mid-January 2025, we have planned for this possibility. We will update shareholders as these plans are finalized, though our focus will remain on further evidence generation in parallel with the reconsideration pathway made available to all providers seeking Medicare coverage of their tests.' Notes: 1 PEB has released the information contained in this update to the NZX and ASX as it regards it to be material, as defined in the NZX Listing Rules and Section 231 of the FMC Act. 2 Centers for Medicare and Medicaid Services. 3 The Department of Health and Human Services. 4 Office of the General Counsel (of the Department of Health and Human Services). 5 Under current legislation, MACs are required to consider consensus statements and/or guidelines in determining coverage.
Scoop
27-04-2025
- Health
- Scoop
Medicare LCD Effective; Pacific Edge Seeks Recoverage
Pacific Edge notes the 'Genetic Testing in Oncology: Specific Tests' (L39365) Local Coverage Determination became effective on 24 April 2025 in the US, halting Medicare coverage of Cxbladder tests. Pacific Edge filed for a preliminary injunction and undertook political advocacy efforts directed at the incoming political appointees within CMS2, HHS3 and OGC4 that included substantial support from the American Urological Association (AUA). However, on Wednesday 23 April 2025 a Pennsylvania District Court Judge ruled that her court lacks jurisdiction to hear Pacific Edge's claim against Medicare Administrative Contractor Novitas and CMS. Meanwhile, the lobbying efforts have not yielded a change to the effective date or retirement of the LCD. Pacific Edge, which currently generates ~60% of its US revenue from Medicare, will now focus on the paths available, which include Medicare appeals for Cxbladder Triage to get paid based on its inclusion in the AUA microhematuria guideline5, despite the non-coverage determination and reconsideration requests for Triage and Monitor. Pacific Edge submitted a reconsideration request for Cxbladder Triage under 'Biomarkers for Oncology' LCD (L35396) on 21 March 2025, a request that has already been deemed valid by Novitas, meaning they will now assess the evidence submitted. It also expects to submit a reconsideration request for Cxbladder Monitor under 'Genetic Testing in Oncology: Specific Tests' (L39365) as soon as possible and request non-coverage to be removed. However, Pacific Edge will not seek re-coverage of Cxbladder Detect as no new evidence has been published that can be submitted for reconsideration. Detect users will be required to move over to Triage in an acceleration of a plan intended to coincide with the commercial launch of Triage Plus. Novitas controls the timeline for these reconsideration requests and is not bound by any maximum period to complete this work. Industry experts typically estimate the time at 6-9 months for a valid submission of a single product with only a small number of new supporting publications and not the protracted period of consultation that results from creating a new LCD as was done with L39365. Regarding Cxbladder Triage Plus, the company will continue to develop, publish and subsequently submit a reconsideration request in line with our previously published roadmap – those activities remain on track. The company will also continue to work with Kaiser Permanente on a peer-reviewed publication confirming the real-world utility of Cxbladder Triage. The preliminary data was presented as a poster at the AUA 2025 annual meeting (April 26–29) in Las Vegas and will be used for future reconsideration requests when published. While the impact of 'Genetic Testing for Oncology: Specific Tests' (L39365) is expected to have a significant impact on testing volume, Pacific Edge expects to continue to bill and receive reimbursement from contracted commercial US payers without interruption, notably Kaiser Permanente, the US Veterans Administration, various Blue Cross Blue Shield plans under the group purchasing agreement and from non-contracted private payers in line with historic reimbursement rates. Similarly, Pacific Edge expects collections from our enhanced patient responsibility and patient assistance programs to continue in line with the rates since the introduction of that program in July 2023. Pacific Edge Chief Executive Dr Peter Meintjes said: 'This finalization is a poor outcome for Medicare patients and urologists, as it removes coverage for guideline-recommended testing and followed a flawed process that failed to review the most-current evidence. 'We are obviously disappointed we have been unable to maintain coverage of our tests in the short term. However, as we noted when the final LCD was published in mid-January 2025, we have planned for this possibility. We will update shareholders as these plans are finalized, though our focus will remain on further evidence generation in parallel with the reconsideration pathway made available to all providers seeking Medicare coverage of their tests.' Notes: 1 PEB has released the information contained in this update to the NZX and ASX as it regards it to be material, as defined in the NZX Listing Rules and Section 231 of the FMC Act. 2 Centers for Medicare and Medicaid Services. 3 The Department of Health and Human Services. 4 Office of the General Counsel (of the Department of Health and Human Services). 5 Under current legislation, MACs are required to consider consensus statements and/or guidelines in determining coverage.
