Health Law
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Supreme Court to hear $12B ACA risk corridors case this week
The justices will consider the case Tuesday. Observers say the money will not be the ultimate thrust of the court's decision — it's whether the business sector will have trust in the federal government in current and future partnerships.
By Ron Shinkman • Dec. 09, 2019 -
Dive Awards
Disruptor of the Year: The Affordable Care Act lawsuit
An unexpected ruling at the end of 2018 invalidating the ACA paved the way for even more uncertainty for the landmark law, following a decade of upheaval. The case is nearly certain to end up before the Supreme Court.
By Dana Elfin • Dec. 09, 2019 -
Dive Awards
The Healthcare Dive Awards for 2019
From the Affordable Care Act lawsuit to CVS Health CEO Larry Merlo, these are the companies, executives and movements that shaped U.S. healthcare this year.
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More than 1K employers push Senate to repeal ACA Cadillac tax
AHIP and the U.S. Chamber of Commerce were among those arguing the tax will have sweeping effects beyond just "gold-plated" health coverage and will raise costs for the millions of Americans with employer coverage.
By Rebecca Pifer • Dec. 06, 2019 -
More state laws back telehealth, but many stop short of mandates
While regulations have inhibited growth in the past, many states are warming up to the adoption of virtual services. That's a "sea change compared to a decade ago," Foley & Lardner lawyers said.
By Linda Wilson • Dec. 05, 2019 -
Deep DiveWill sky-high drug prices spur the US to use an obscure power over patents?
New cell therapies as well as gene-based treatments like Zolgensma benefited from NIH funding of early-stage research. Advocates say the time is now for the government to invoke its "march-in" rights.
By Jonathan Gardner • Dec. 04, 2019 -
'Refusal to properly report' data breach spurs $2.175M fine for Sentara Hospitals
"When healthcare providers blatantly fail to report breaches as required by law, they should expect vigorous enforcement action," HHS Office of Civil Rights chief Roger Severino said.
By Ron Shinkman • Dec. 02, 2019 -
Michigan focus of latest lawsuit over Medicaid work rules
It's the latest court protest of Medicaid work requirements in the nine states that obtained waivers. Most of the challenges have prevailed.
By Ron Shinkman • Nov. 25, 2019 -
Sutter to pay $45M on DOJ kickback, overbilling claims
The dominant system serving Northern California has agreed to pay about $75 million to settle various claims so far this year. The latest claims relate to alleged financial arrangements with physicians to incentivize them to refer patients to Sutter.
By Samantha Liss • Nov. 18, 2019 -
IT execs call for HIPAA overhaul in 'Project Nightingale' wake
"People aren't doing anything against the law, but we're starting to think differently," Geisinger's chief informatics data officer said. "There's the legal court and then the court of public opinion, and that's starting to shift a little bit."
By Rebecca Pifer • Nov. 18, 2019 -
Consumers more likely to leave ACA after their insurer exits
A Health Affairs study also found that shoppers not qualifying for federal premium subsidies were twice as likely to leave when their payer did.
By Linda Wilson • Nov. 06, 2019 -
Execs flirt with 'Medicare for All' at HLTH19, despite Trump admin warnings
"Until we see a better idea, it's actually not a bad framework to have a debate around," said the CEO of Medicare Advantage startup Clover Health.
By Rebecca Pifer • Nov. 04, 2019 -
Litigation prompts Indiana to drop Medicaid work requirement for now
State officials had said the regulation might reduce its Medicaid rolls by about 5%, or 70,000 out of a total enrollment of 1.4 million.
By Ron Shinkman • Nov. 01, 2019 -
California AG blocks Adventist, St. Joseph union
The decision comes closely after AG Xavier Becerra reached a settlement with the giant regional player Sutter Health in a fight over anti-competitive practices.
By Samantha Liss • Nov. 01, 2019 -
CMS chief Verma teases more Medicaid deregulation
Speaking at the HLTH conference Sunday, Verma also said that as long as states continue to approach CMS with requests for Medicaid work requirements, the agency would approve them.
By Rebecca Pifer • Oct. 28, 2019 -
US ordered to cough up $1.59B in subsidies to Kaiser, Oscar, other payers
Among the largest creditors in the case are Kaiser Foundation Health Plan, which is owed more than $220 million in cost-sharing reduction subsidies, and Blue Shield of California, with more than $132 million outstanding.
By Dana Elfin • Oct. 25, 2019 -
Verma dodges on backup plan if ACA is struck down
Democrats accused the CMS administrator of stonewalling in her testimony in front of a House committee Wednesday, with a federal appeals court ruling on the fate of the landmark law expected any day.
By Rebecca Pifer • Oct. 23, 2019 -
Trump admin touts dip in ACA exchange plan premiums
On average, those shopping for plans on the exchange will have more options at a lower price, CMS Administrator Seema Verma said Monday on a call with reporters.
By Samantha Liss • Oct. 22, 2019 -
FTC takes aim at state-shielded rural monopolies
The agency will study certificates of public advantage in three states — Tennessee, Virginia and West Virginia — that immunized certain health system mergers from federal antitrust scrutiny.
By Samantha Liss • Oct. 22, 2019 -
Sutter settles antitrust case, terms unknown
The agreement, reached just as the landmark trial was set to begin, is expected to be finalized in February or March.
By Dana Elfin • UPDATED: Oct. 18, 2019 at 8:51 a.m. -
Oscar files appeal in battle with Florida Blue over exclusive broker policies
A federal judge ruled against the startup last month, despite the U.S. Department of Justice arguing the case should not be tossed.
By Samantha Liss • Oct. 15, 2019 -
As Medicaid work requirements cost taxpayers $408M, government watchdog calls for more oversight
"More money, fewer people with care. And you paid for 87% of it!" Andy Slavitt, who headed up CMS under former President Barack Obama, tweeted of the administrative costs associated with Medicaid work requirements.
By Samantha Liss • Oct. 11, 2019 -
Idaho latest to attempt work requirement for Medicaid expansion
More than a dozen states across the country have sought approval to impose work requirements on Medicaid enrollees, but judges have blocked previous proposals.
By Samantha Liss • Sept. 30, 2019 -
Sutter antitrust trial opens, with implications for M&A across US
A ruling against the hospital system would send waves through the hundreds of providers that have been steadily consolidating in the past 25 years. A win could send prices both in California and the rest of the nation even higher.
By Ron Shinkman • Sept. 23, 2019 -
Judge dismisses Oscar antitrust lawsuit against Florida BCBS
Florida Blue's contract requiring brokers to sell insurance only for Florida Blue or risk losing access to all of its product lines is lawful, the federal judge wrote in his opinion.
By Rebecca Pifer • Sept. 23, 2019
