Health Law

Payer participation in ACA exchanges rises for third year in a row: KFF

The Kaiser Family Foundation found 30 insurers joined the marketplace across 20 states, while another 61 expanded in existing regions for the 2021 plan year.

By Rebecca Pifer • Nov. 25, 2020

COVID-19 is making it harder for some middle income patients to pay premiums, deductibles: report

The economic impact from COVID-19 could make it harder for workers to pay for their share of employee-sponsored healthcare coverage, a survey from The Commonwealth Fund found.

By Ron Shinkman • Nov. 24, 2020

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Trendline

Labor

While labor strife among healthcare workers is hardly new, the COVID-19 pandemic brought new issues to the table, including re-use of personal protective equipment and other safety measures.

By Healthcare Dive staff

FTC signals nurses' wages will become important measure in antitrust enforcement

The agency has largely focused on the impact mergers have on prices. This new tactic could give it another legal argument to challenge tie-ups.

By Samantha Liss • Nov. 19, 2020

FTC sues to block Tenet's Memphis hospital deal with Methodist Le Bonheur

The agency is alleging the $350 million tie-up would harm consumers in the form of higher prices, including increased insurance premiums.

By Samantha Liss • UPDATED: Nov. 16, 2020 at 8:48 a.m.

No leg to stand on? Supreme Court justices harp on key legal concept in ACA case

Justice Neil Gorsuch seemed skeptical over plaintiffs' injuries and what they want reprieve from. "I guess I'm a little unclear who exactly they want me to enjoin and what exactly do they want me to enjoin them from doing?"

By Samantha Liss • Nov. 13, 2020

Kavanaugh, Roberts signal support for ACA without mandate in pivotal case

During oral arguments before the Supreme Court, the justices pointed to the court's preference for removing provisions that are unconstitutional without striking down the entirety of a law.

By Samantha Liss • Nov. 10, 2020

The Affordable Care Act before the US Supreme Court

The ACA has been in peril before, including before the country's highest court. But with a newly seated conservative justice, the decade-old law faces another major challenge. Here's a roundup of Healthcare Dive's coverage.

By Samantha Liss • Nov. 10, 2020

As pivotal ACA case heads to Supreme Court, potential outcomes are many

Legal analysts say it's not a choice between simply two results. "I think about it as a spectrum," Katie Keith, a lawyer and health policy expert at Georgetown University​, said.

By Samantha Liss • Nov. 04, 2020

Aetna to pay $1M to settle 3 patient data HIPAA breaches

The potential violations all occurred over a six-month period in 2017 and affected a total of more than 18,000 members, the HHS Office for Civil Rights said. The payer is not admiting liability.

By Shannon Muchmore • Oct. 29, 2020

AHA, AMA ask Congress to extend suspension of Medicare sequester

The 2% payment cut was suspended under the CARES Act, but providers say the ongoing financial pain they are feeling due to the COVID-19 pandemic means it should continue to be on hold well into next year.

By Ron Shinkman • Oct. 23, 2020

CMS approves controversial Medicaid waiver in Nebraska, creating 2-tiered system

The expansion is a more creative way to implement work or job training requirements, but opponents argue it will deprive some enrollees of benefits.

By Samantha Liss • Oct. 21, 2020

Deep Dive

Retail's role, focus on equity, value-based pay amid COVID-19: takeaways from HLTH 2020

Back-to-work products, coronavirus vaccine distribution and telehealth ROI were also hot topics at the conference's third year.

By Rebecca Pifer • Oct. 19, 2020

Baffled judges press AHA: Why is an X-ray price 'unknowable?'

Some legal experts say the hearing was pivotal in the push toward price transparency and are advising clients to get ready for Jan. 1 as a victory for the hospital lobby appears unlikely.

By Samantha Liss • Oct. 16, 2020

CMS grants Medicaid waiver to Georgia; exchange opt-out remains on table

The agency has approved a modest Medicaid expansion waiver for Georgia, and is apparently nearing OK of a second waiver that would allow the state to stop using the Healthcare.gov insurance exchange.

By Ron Shinkman • Oct. 15, 2020

Sponsored by IQVIA

4 key steps in preparing for the 21st Century Cures Act interoperability standards

Is your organization ready for the Cures Act? Learn the four key steps for creating an action plan.

By Ted Marsh and Steven Schneiderman, Practice Leads, IQVIA Healthcare Solutions • Oct. 09, 2020

Deep Dive

Election 2020: Trump and Biden's starkly diverging views on healthcare

Spoiler: the two nominees diverge on almost everything.

By Rebecca Pifer • Oct. 01, 2020

$6B fraud bust includes numerous telehealth schemes

Providers quickly pivoted many services to virtual care during the COVID-19 pandemic, potentially inviting fraud.

By Shannon Muchmore • Oct. 01, 2020

Providers win Medicare loan extension, DSH relief but lose other asks in stop-gap spending law

The law signed by the president Thursday is likely the only direct aid providers can expect before the November presidential election, after Congress deadlocked on further COVID-19 legislation.

By Rebecca Pifer • Oct. 01, 2020

What Trump's SCOTUS pick could mean for the ACA challenge

Amy Coney Barrett has criticized Chief Justice John Roberts' reasoning in upholding the landmark law in an earlier case.

By Samantha Liss • Sept. 28, 2020

Centene sues drugmaker Indivior over 'profit protection scheme'

The payer is seeking to recoup money it paid for opioid addiction medicines that should have had generic equivalents — or cheaper alternatives. It alleged the drug company devised a plan to box out competitors.

By Samantha Liss • UPDATED: Sept. 23, 2020 at 11:47 a.m.

'People should worry:' ACA in limbo after Ruth Bader Ginsburg's passing

Backers of the Affordable Care Act fear the new balance on the Supreme Court imperils its survival, but optimists look to where two conservative justices sit on the issue of severability.

By Samantha Liss • Sept. 19, 2020

OSHA fines 3 hospital systems for PPE violations

Bergen New Bridge Medical Center said Monday afternoon it had not received the OSHA report but will "respond accordingly" when it does. The other two hospitals have not responded to requests for comment.

By Ron Shinkman • UPDATED: Sept. 15, 2020 at 10:12 a.m.

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

Medicaid enrollment has jumped 4.3M since February, could grow much more

By contrast, between February and August of last year, Medicaid enrollment averaged a decrease of 0.7% among all states, a report from Families USA found.

By Ron Shinkman • Sept. 08, 2020

Neither Anthem nor Cigna win damages in 'corporate soap opera' merger fight

The two payers "must deal independently with the consequences of their costly and ill-fated attempt" at a $54 billion union that ultimately failed, a court ruled.

By Samantha Liss • Sept. 01, 2020