OIG says $2.6B paid out under MA risk adjustment with scant encounter data

The watchdog's analysis also found health risk assessments were taking place at a patient's home, and were often conducted by providers contracted by the health plan instead of their actual physician.

By Ron Shinkman • Sept. 11, 2020

Employers struggling to calculate 2021 medical cost trends due to COVID-19: Credit Suisse

A survey run by the financial services firm found 60% of employers are trying to adjust 2020 claims data to normalize for the pandemic's effects while calculating expected medical cost trend next year.

By Rebecca Pifer • Sept. 11, 2020

West Virginia hospital to pay $50M to settle False Claims Act violations

DOJ alleges Wheeling Hospital paid physicians well above market value for referring patients to the facility — in some cases over $1 million a year — from 2007 to 2020, defrauding Medicare of tens of millions of dollars.

By Rebecca Pifer • Sept. 10, 2020

5 ways to set up health plan sales teams for success

Equip your sales organization to deal with the current near-term uncertainties and be best positioned for success in the long term.

By Jeff Traenkner • Sept. 10, 2020

Hospitals urge HHS to step in on 340B fight with drug manufacturers

On Friday, more than 1,100 hospitals sent another letter to HHS urging it to take action against drug manufacturers limiting drug distribution to 340B facilities.

By Shannon Muchmore • Updated Sept. 11, 2020

Federal COVID-19 cash saved most hospitals from bleakest forecasts: MedPAC

But any new congressional relief is stalled in Congress, and an HCA official warned cost-cutting initiatives that helped operators aren't sustainable.

By Rebecca Pifer • Sept. 4, 2020

Here's how nonprofit hospitals weathered the first half of 2020

"In the absence of stimulus relief and rebounding elective procedural volumes, the sector would have taken a considerable shock to all key financial metrics," Fitch Ratings said.

Sept. 3, 2020

Northwell says COVID-19 has inflicted $1.2B hit to date

The New York-area nonprofit hospital system posted a year-over-year deficit of $250 million for the first half of 2020, as operating expenses rose 9.5%.

By Ron Shinkman • Aug. 31, 2020

Investment returns boost Cleveland Clinic into the black despite weak Q2 revenue

Like many other major operators, Cleveland Clinic also benefited from millions in government assistance, including $324 million in CARES relief grants.

By Rebecca Pifer • Aug. 31, 2020

Investment losses, flagging volume push UPMC into the red in H1

The Pittsburgh-based nonprofit reported a loss of $165 million, down from a profit of $372 million the same time last year.

By Rebecca Pifer • Aug. 27, 2020

Amwell files IPO with $100M boost from Google

Amwell, one of the country's biggest telehealth companies, will become Google Cloud's preferred telehealth platform as part of the multiyear partnership.

By Rebecca Pifer • Aug. 25, 2020

Advocate Aurora profit inches up in Q2 as investment income bounces back

The Illinois-based nonprofit, which is currently exploring a merger with Michigan's largest health system, still saw its operating margin plummet from 5.7% to -6.8% in the quarter.

By Shannon Muchmore • Aug. 25, 2020

Mayo Clinic Q2 profit plummets under COVID-19 strain, but still in the black

The pandemic led the nonprofit system to cut its supplemental and contract workforce, halt most of its construction projects and reduce staff salaries.

By Ron Shinkman • Aug. 21, 2020

Sutter posts $857M loss in H1 on investment, operational declines

Sutter joins other major nonprofit health systems in posting net losses for the first half of the year despite $400 million in financial assistance from the federal government.

By Samantha Liss • Aug. 21, 2020

Providence $538M loss shows pandemic woes trump bailout funds in H1

Unlike some other major hospital systems buoyed by federal funds, including Kaiser and the biggest for-profits, expenses and volume depression threw the Washington state system's financials into the red.

By Samantha Liss • Aug. 18, 2020

Banner, battered by COVID-19 in Arizona and beyond, sees H1 net loss

Still, the nonprofit system's size and breadth of business is likely to keep it afloat, analysts have said. The organization received $400 million in federal COVID-19 relief funding and has more than 250 days cash on hand.

By Hailey Mensik • Aug. 14, 2020

HHS sending $1.4B from COVID-19 bailout funds to children's hospitals

Certain free-standing children's hospitals not affiliated with larger systems will be eligible to receive 2.5% of their net revenue from patient care and will begin receiving the money this week.

By Hailey Mensik • Aug. 14, 2020

Telemedicine, remote monitoring hottest 2020 digital health startups, CB Insight finds

Twelve unicorn companies are on this year's list, including Ro, a telehealth platform that provides remote care and medication delivery services, and insurer Oscar.

By Hailey Mensik • Aug. 13, 2020

One Medical beats Q2 estimates, rolls out new telehealth option

The primary care chain that went public earlier this year also said it's entering North Carolina and Wisconsin, bringing its presence to 15 markets.

By Shannon Muchmore • Aug. 13, 2020

Regional chains Sentara, Cone to merge into 17-hospital, $11.5B system

The Norfolk, Virginia- and Greensboro, North Carolina-based providers plan to complete the union in the middle of next year. M&A activity hasn't slowed as much as some expected amid the pandemic.

By Hailey Mensik , Shannon Muchmore • Aug. 12, 2020

20 state AGs urge Trump admin to nix proposed tax breaks for health sharing ministries

Saying it would undermine the Affordable Care Act and encourage fraud, the attorneys general called a draft rule arbitrary and particularly dangerous amid the COVID-19 pandemic.

By Ron Shinkman • Aug. 12, 2020

New CMS value-based payment model aimed at rural hospitals, ACOs

The program will include upfront and capitated payments for providers as well as some regulatory flexibilities. It will require facilities to partner with state Medicaid agencies in an attempt to improve care coordination.

By Shannon Muchmore • Aug. 11, 2020

OIG says hospitals overbilled Medicare $267M by improperly coding post-discharge services

The watchdog recommended CMS direct its recovery audit contractors to recoup overpayments made within the past four years.

By Ron Shinkman • Aug. 10, 2020

Buoyed by bailout funds, all major for-profit hospital chains reported increased profits in Q2

The second quarter was expected to be devastating for hospitals as the pandemic forced many to stop business as usual. The results raise questions about whether federal bailout funds were meant to pad the bottom line.

By Samantha Liss • Aug. 10, 2020

Telehealth claims dipped in May, but still up 5,680% from year ago: Fair Health

The latest insurance data found private claims for virtual care fell 33% from April, but are still wildly up amid lockdowns and the ongoing pandemic.

By Ron Shinkman • Aug. 7, 2020