Health Law

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.

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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

'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

Jury rules Centene underpaid TeamHealth physicians in Arkansas, awards $9.4M

The private-equity backed staffing firm has been turning to courts to argue insurers have been paying its emergency physicians too-low rates, with more than 25 lawsuits across the country.

By Samantha Liss • Aug. 21, 2020

Supreme Court to hear ACA arguments after November election

The choice to wait until after voters go to the polls may have been intentional, legal experts said. Regardless, the high court is not likely to issue a final ruling until next year.

By Samantha Liss • Aug. 19, 2020

Payers win again, court rules Trump admin violated law in axing ACA cost-sharing payments

Judges said, however, that insurers able to raise premiums to offset the loss of the payments in 2018 should not receive the entire unpaid amount.

By Shannon Muchmore • Aug. 14, 2020

Cigna sued over COVID-19 treatment, testing payment

A New Jersey medical office alleges it is owed nearly $400,000 from the insurer, which it claims has arbitrarily refused to make payment in violation of the Coronavirus Aid, Relief, and Economic Security Act.

By Samantha Liss • Aug. 14, 2020

As Congress eyes an inquiry into insurer profits, experts caution they may not last

"One thing that we can be certain of is that the lower level of claims cost experienced in the second quarter will not continue indefinitely," Bradley Ellis, senior director of North American insurance ratings for Fitch Ratings, said.

By Samantha Liss • Aug. 12, 2020

Biden VP pick Harris, early backer of 'Medicare for All,' later pivoted

Among the largest donors to Sen. Kamala Harris' primary run were workers, owners and political action committees associated with healthcare powerhouse Kaiser Permanente.

By Shannon Muchmore • Aug. 12, 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

DOJ sues Cigna, alleging $1.4B in Medicare Advantage fraud

The payer used a medical assessment program to find health conditions that could raise risk scores of plan members, offering incentives to physicians who gave the exam, according to the lawsuit.

By Hailey Mensik • Aug. 06, 2020

Fresh off Medicaid win in Missouri, Fairness Project calls for health industry to step up

"We need to see health insurers and private hospitals step up and make massive investments in these campaigns," Jonathan Schleifer, executive director of the D.C.-based advocacy group, told Healthcare Dive.

By Samantha Liss • Aug. 06, 2020

DOJ moves to block Geisinger Health's tie-up with Evangelical Community Hospital

The lawsuit alleges that in exchange for 30% ownership, Geisinger would invest $100 million in Evangelical. But the money is "not without strings," according to DOJ, which argues it ends any competition.

By Samantha Liss • Aug. 06, 2020

Hospitals lose legal challenge to 340B drug payment cut

The 2-1 ruling overturns a district court decision that HHS overstepped its bounds when it cut the reimbursement rate for a certain category of outpatient drugs by 28.5% for hospitals enrolled in the drug discount program.

By Shannon Muchmore • July 31, 2020

HHS prods Congress to act on surprise billing, but doesn't take a side on how

Congress has taken some action on surprise billing in the face of the coronavirus pandemic, barring the practice for COVID-19 testing and treatment during the public health emergency. Still, a larger overhaul is unlikely soon.

By Shannon Muchmore • July 29, 2020

Lifespan pays $1M to settle potential HIPAA violations over stolen laptop breach

HHS found "systemic noncompliance" with the privacy law and a lack of control over devices on this type of issue. The nonprofit health system contends there is no indication the information was accessed.

By Samantha Liss • July 28, 2020

6 months in: The COVID-19 crisis

This series of stories examines how healthcare has changed during the course of the novel coronavirus in the United States, half a year after HHS declared a national public health emergency.

HHS reminds providers of civil rights obligations amid COVID-19 race disparities

The agency on Monday said it's seen an uptick in complaints since the pandemic began and issued guidance to ensure providers comply with federal civil rights laws.

By Hailey Mensik • July 21, 2020

California, 22 other AGs sue Trump admin over rolling back transgender protections

The coalition argues the pullback of Affordable Care Act protections related to how sex discrimination is determined during a global pandemic is particularly egregious. 

By Samantha Liss • July 20, 2020

As Congress weighs next COVID-19 relief bill, 4 healthcare sticking points

For one, hospitals want $100 billion more in federal aid, a figure endorsed by House Democrats but likely to be whittled down by Senate Republicans.

By Rebecca Pifer , Samantha Liss • July 20, 2020

Appeals court upholds Trump admin's expansion of short-term health plans

The Association of Community Affiliated Plans said it would appeal Friday's decision, slamming the bare-bones plans — which sparked a yearlong Democrat committee investigation — as "junk insurance."

By Rebecca Pifer • July 17, 2020