CVS sues to prevent $2B Medicare Advantage star ratings hit

The Latest

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  ONC cuts health IT certification criteria in HTI-5 final rule

  The regulation cuts 14 criteria and revises seven to make ONC's health IT certification easier to achieve, but delays decisions on information blocking.

  Health IT

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  Q&A

  Prior authorization in the real world: Takeaways from Epic ahead of looming API deadline

  As a Jan. 1 deadline looms for payers to adopt new prior authorization tech, Epic’s Vice President of Value-Based Care Ryan Bohochik breaks down the industry’s progress so far.

  Payer

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  CMS proposes heightened standards for ACA financial assistance

  Enrollees must jump through more hoops to verify their income and residency status before receiving subsidies for Affordable Care Act plans. Over 300,000 enrollees are expected to leave each year as a result.

  Payer

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  Centene sues the CMS over 2027 Medicare Advantage star ratings

  The St. Louis-based insurer is adding onto a growing pile of lawsuits from insurers trying to get their quality scores recalculated — and nab hundreds of millions of dollars in extra payments as a result.

  Payer

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  Uninsured rate rises to 11% ahead of Medicaid work requirements

  Cuts to federal programs and the loss of enhanced subsidies on the exchanges could deepen an existing healthcare affordability crisis, according to a new report from the Commonwealth Fund.

  Payer

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  5 major companies pledge faster, electronic prior authorizations

  Amazon, Google, Meta and other employers agreed to reform their prior authorization policies for their self-funded health plans, which provide coverage for millions of Americans.

  Payer

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  Molina joins Medicaid recovery bandwagon despite mixed Q3

  It’s the latest insurer to report momentum in the safety-net insurance program as states increase their payment rates and costs plateau. “The imbalance between rates and trend appears to have stabilized,” Molina’s CEO said.

  Payer

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  Quest Diagnostics hit by cyberattack

  The testing company believes an unauthorized third party accessed patient records.

  Health IT

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  Top healthcare conferences to attend in 2027

  These are the best industry events for digital health, provider and payer leaders to attend next year.

  Hospitals

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  Risant Health to acquire Oklahoma system Integris Health

  The acquisition is set to give Integris access to extra capital and technology at a time when many health systems are being hit by rising expenses.

  Hospitals

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  Developers, not doctors, should be held accountable for generative AI medical devices, providers say

  Provider groups are lobbying the Food and Drug Administration to make tech companies responsible for the safety and performance of generative AI-backed medical devices, arguing the tools’ makers are best equipped to evaluate them.

  Health IT

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  Elevance sees Medicaid momentum in Q3

  States jacked up their Medicaid rates in July, a positive development for the insurer. Elevance now thinks its Medicaid margin will be better than its prior expectation of -1.75% this year.

  Payer

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  Ghost networks haunt mental health access, study finds

  A secret shopper study found less than a quarter of calls to mental health clinicians resulted in appointments, with directory errors and unreachable providers driving so-called "ghost" networks.

  Payer

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  Hackensack Meridian, Hunterdon pen merger agreement

  As part of the deal, which still needs to be approved by regulators, Hackensack will invest about $230 million to improve Hunterdon’s facilities and roll out Epic’s electronic health record.

  Hospitals

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  Centene, Oscar, UnitedHealthcare sidle into some new counties in 2027 ACA plans

  The major insurers are entering new Affordable Care Act markets as others are leaving the exchanges en masse, though in the cases of Centene and UnitedHealthcare, county additions paper over larger state exits.

  Payer

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  OpenEvidence, Doximity settle thorny AI legal battle

  The health AI companies are putting to bed a legal dispute involving dueling lawsuits, claims of corporate espionage and allegations of harassment.

  Health IT

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  Tracker

  Tracking healthcare data breaches

  A vendor that processes some of California's state Medicaid billing experienced a data breach last fall that impacted more than 970,000 people, according to a new filing with the HHS.

  Updated Oct. 20, 2026

  Hospitals

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  5 doctors weigh in on the promise, limitations of a closely watched multicancer blood test

  As a screening test from Grail moves closer to Food and Drug Administration approval, cancer experts share what encourages and concerns them most about Galleri.

  Government

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  CMS proposes rule to clean up MA provider directories, shine light on PBMs

  The proposed changes would implement key healthcare provisions in a government funding package from February. The brunt of the reforms would go into effect in 2028.

  Payer

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  Drugmakers seek to intervene in lawsuit challenging 340B pilot

  Drugmakers want a say in court to defend a rebate pilot in the 340B drug discount program that hospitals are trying to stop.

  Hospitals

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  Trade association sues Trump administration over ACA broker, agent freeze

  The National Association of Benefits and Insurance Professionals alleges that the HHS violated the law by not giving the public a chance to comment on the controversial policy.

  Payer

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  3 tips to manage soaring health costs

  Speaking at the CFO Leadership Council’s fall conference in Colorado, Marsh McLennan Senior VP Marybeth Gray shared ideas to keep employees healthy and costs down.

  Payer

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  Health-ISAC, Microsoft and partners take down popular phishing kit services

  Microsoft and the healthcare industry’s information sharing and analysis center have teamed up to disrupt a prolific China-based phishing ecosystem.

  Health IT

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  Rush, Endeavor to merge into Illinois powerhouse

  Joining forces could give the two Chicagoland systems a leg up in the region’s fragmented and competitive hospital market — if regulators approve.

  Hospitals

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  Zocdoc acquires Sohar Health in latest push to scale tech infrastructure

  It’s Zocdoc’s first acquisition in its nearly 20-year history as the online medical scheduling company works to scale. Sohar already provides insurance eligibility checks within Zocdoc’s appointment scheduling platform.

  Health IT

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