Health Law

Sutter requests competitor pricing data as part of antitrust lawsuit

Hospitals have balked at the request, saying the information is proprietary.

By Les Masterson • Oct. 17, 2018
#AHIPMMD: Verma touts MA growth, blasts Medicare for all

So far, 270 Medicare Advantage plans will offer new benefits allowed for 2019 that include adult day care and meals, the CMS administrator said at the annual payer conference.

By Samantha Liss • Oct. 17, 2018
Immigration rule change could force millions off Medicaid, report warns

The Trump administration is proposing a change to "public charge" policies that could also lead to higher costs for providers via uncompensated care and more ER visits, according to the Kaiser Family Foundation.

By Les Masterson • Oct. 15, 2018
NLRB charges Detroit Medical Center with unfair labor practices

Nurses at Huron Valley-Sinai Hospital, who have been negotiating a union contract since 2016, have said the hospital is discriminating and not bargaining in good faith.

By Tony Abraham • Oct. 11, 2018
Court awards $1.2M in missed CSR payments to Montana co-op

A judge last month ruled the government was statutorily obligated to make the payments and the obligation "was not vitiated by Congress's failure to appropriate funds for that purpose."

By Les Masterson • Oct. 09, 2018
New plans in Iowa don't offer pre-existing condition protections

Meanwhile, a federal judge scheduled a hearing on short-term health plans for Oct. 26. The plaintiffs filed a motion in September arguing those plans will harm the health insurance industry.

By Les Masterson • Oct. 05, 2018
CVS, Aetna defend merger potential to Connecticut regulators

The $69 billion deal is considered to have a good chance for approval. Aetna agreed last week to sell its standalone Medicare Part D business to help clear antitrust hurdles.

By Samantha Liss • Oct. 05, 2018
Opioid interventions can curb overprescribing, boost MAT access, JAMA studies show

Though the root cause of the opioid crisis is still being debated, many attribute it to the rapid growth in prescribing starting in the 1990s and peaking in 2012 — a 300% expansion according to some metrics.

By Rebecca Pifer • Sept. 28, 2018
Bipartisan opioid bill has IMD exclusion, expands MAT

The legislation, which also opens up non-addictive pain management alternatives and increases enforcement of illegal fentanyl, is expected to pass both houses as early as next month.

By Les Masterson • Sept. 27, 2018
Safety-net hospitals get break on FY19 readmission penalties, analysis finds

Some penalties are being cut by half or more, and 65 safety-net facilities that were penalized last year will see no dock at all this year, according to a data review by Kaiser Health News.

By Les Masterson • Sept. 27, 2018
Maryland reinsurance program credited for premium decreases

Before CMS approved the program, the state's four individual health plans requested an average increase of 30.2%, but they have now put forward rates with an average decrease of 13.2%.

By Les Masterson • Sept. 26, 2018
New York regulator warns CVS-Aetna merger could raise prices, reduce consumer choice

The state's top financial watchdog said the pharmacy chain's PBM would have an incentive to give the largest drug discounts to Aetna members, causing "anti-competitive effects" in the rest of the market.

By Samantha Liss • Sept. 26, 2018
CHS subsidiary coughs up $262M for fraud settlement

Health Management Associates incorrectly billed government payers in a physician kickback scheme between 2008 and 2012. With the settlement, the government agreed not to bring criminal charges against the hospital chain.

By Tony Abraham • Sept. 26, 2018
TV filming at Massachusetts hospitals leads to $1M in HIPAA fines

Boston Medical, Brigham and Women's and Massachusetts General were hit with the fines for allowing ABC documentary crews for "Save My Life: Boston Trauma" to tape patients on premises without obtaining prior authorization.

By Tony Abraham • Sept. 21, 2018
Challenge to short-term plans joins chorus of ACA lawsuits

While the outcome of a lawsuit threatening the landmark law is pending in Texas, patient advocates in Washington, D.C., and the Maryland attorney general are suing to protect the act.

By Les Masterson • Sept. 17, 2018
Managed care companies, providers would benefit from Medicaid expansion

Four states with ballot initiatives this fall to expand Medicaid could boost bottom lines of big-name payers and health systems, according to a new report.

By Les Masterson • Sept. 12, 2018
California law brings more scrutiny of payer mergers

Payers must get approval from the state for any transaction that affects a "significant number of enrollees," "involves a material amount of assets" or adversely affects "the stability of the health care delivery system."

By Les Masterson • Sept. 12, 2018
In big payer win, court sides with UnitedHealth on MA overpayment rule

A federal judge vacated the rule, which the insurers said created additional burdens for Medicare Advantage plans not consistent with traditional Medicare regulations.

By Les Masterson • Sept. 10, 2018
Montana co-op wins $5.3M CSR lawsuit

The judge ruled that the federal government didn't fulfill its obligation under the ACA when it stopped the cost-sharing reduction payments last year.

By Les Masterson • Sept. 07, 2018
Federal judge mulls ACA's constitutional standing

The Texas judge is reportedly "strongly considering" that the ACA is unconstitutional without its individual mandate penalty. A decision on the lawsuit could arrive any time before the end of the year.

By Tony Abraham • Sept. 05, 2018
Critics say GOP pre-existing conditions bill flawed

The legislative effort comes as a Republican-backed court case may wipe out the ACA's protections for people with pre-existing conditions.

By Les Masterson • Aug. 28, 2018
HHS asks for advice on anti-kickback rules as industry files Stark Law input

While device makers, physicians, labs and hospitals all agree changes should be made to the Stark Law to boost value-based care, the industry is split on what revisions should be made.

By David Lim • Aug. 27, 2018
Trump seeks federal opioid lawsuit, DOJ aims to slash manufacturing quotas

The president said he'd like Attorney General Jeff Sessions to launch a federal suit in addition to ongoing state legal actions. Meanwhile, the DOJ and DEA proposed further cuts to quotas on opioids for 2019.

By Andrew Dunn • Aug. 20, 2018
Partial Medicaid expansion would restrict access for near-poor adults, study finds

Wisconsin is the only state so far to partially expand the program, but at least three other states are considering such a proposal, according to a Center on Budget and Policy Priorities report.

By Les Masterson • Aug. 15, 2018
Nearly 20% of inpatient admissions include out-of-network charge

A Kaiser Family Foundation report found the issue of surprise billing is especially problematic for care in ERs and for psychological or substance abuse treatment.

By Les Masterson • Aug. 14, 2018