Health Law
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CMS rejects Wyoming's bid to expand Medicaid to regulate air ambulances
The agency said the proposal was in conflict with existing federal law and failed to advance the core objective for the program.
By Samantha Liss • Jan. 16, 2020 -
Racial and ethnic disparities in care narrowed under ACA, Commonwealth Fund says
Previous progress in lowering the uninsured rate stalled after 2016.
By Linda Wilson • Jan. 16, 2020 -
Hospitals, insurers urge Supreme Court to hear ACA case to avert havoc
Lobbying groups said the case could take years to play out without the high court stepping in to hear arguments now.
By Samantha Liss • Jan. 15, 2020 -
AHA files another challenge to CMS site neutral payment policy
The same court ruled in favor of hospitals in September, but later determined it could not keep CMS from attempting the policy again for 2020.
By Shannon Muchmore • Jan. 14, 2020 -
Dignity Health loses appeal of Medicaid out-of-network billing case
The hospital operator said it may try to take the case against L.A. Care, the largest public Medicaid managed care plan in the country, to the California Supreme Court.
By Ron Shinkman • Jan. 13, 2020 -
Supreme Court to take on PBM rate regulation
A federal appeals court previously ruled in favor of pharmacy benefit managers, finding federal law preempts states from regulating their rates.
By Samantha Liss • Jan. 13, 2020 -
Opponents to Supreme Court: No rush to take pivotal ACA case
The Trump administration argues recent decisions removed "any exigency" for the high court to immediately take the case that could upend the landmark law.
By Samantha Liss • UPDATED: Jan. 14, 2020 at 10:06 a.m. -
Kansas to become 37th state to expand Medicaid under ACA
Kansas joins a flurry of Republican-leaning states that have either expanded the program through their legislatures or via voter initiative, including Utah, Idaho and Nebraska.
By Ron Shinkman • Jan. 10, 2020 -
Insurance startup Bright Health eyes California with 1st payer acquisition
The deal is the company's first buy of another health insurer and a pivot to M&A as it pursues an aggressive growth strategy.
By Rebecca Pifer • Jan. 09, 2020 -
DOJ joins whistleblower suit against Indiana system for alleged Stark violation
Community Health Network is accused of submitting as many as hundreds of thousands of fraudulent claims to Medicare and other federal programs from at least 2008 to 2017.
By Rebecca Pifer • Jan. 08, 2020 -
Beyond the ACA: Healthcare legal fights to watch in 2020
Payers and providers are contesting a price transparency push. The Trump administration is also being challenged over risk corridor payments and the expansion of association health plans.
By Shannon Muchmore , Samantha Liss • Jan. 06, 2020 -
Providers embrace loosening Stark Law regulations, suggest feds could go further
The Trump administration's proposed relaxation of regulations around the law has nearly unanimous support in both the hospital and physician community, most of whom say they are chafing against the requirements.
By Ron Shinkman • Jan. 06, 2020 -
Supreme Court says ACA opponents have until Friday to respond to motion to expedite
The court set the deadline Monday after a push by the law's supporters to have the case heard before this year's presidential election.
By Samantha Liss • UPDATED: Jan. 7, 2020 at 10:35 a.m. -
In win for big payers, appeals court sides with HHS in risk adjustment case
AHIP and the Blues argued it would be inconceivable to come up with an entirely new formula for the payments created under the Affordable Care Act.
By Samantha Liss • Jan. 03, 2020 -
Utah Medicaid expansion, with controversial work rules, gets nod
CMS did not approve other elements of the state's request, including charging premiums to adults with incomes above 100% of the federal poverty level and locking people out for violations.
By Linda Wilson • Dec. 24, 2019 -
Focus turns to Supreme Court (again) following ACA ruling
The high court has the discretion to hear the case quickly and potentially issue a decision by next summer, but the case could also face many years of further litigation in lower courts before it ends up in front of the justices, experts said.
By Samantha Liss • Dec. 23, 2019 -
Sutter to pay $575M, change contracting practices in antitrust settlement
Pending approval, the deal bars the dominant Northern California system from using all-or-nothing contracts and stops certain bundling practices.
By Shannon Muchmore • Dec. 20, 2019 -
Landmark health law in limbo after appeals court decision
Without a decisive ruling to uphold or strike down the law, a cloud of uncertainty will persist as the case continues to wind its way through the courts.
By Samantha Liss • Dec. 19, 2019 -
With ACA ruling, payers get unexpected short-term reprieve
Analysts say Wednesday's appeals court decision finding the Affordable Care Act's individual mandate unconstitutional is not the worst thing that could have happened for payers — for now.
By Rebecca Pifer • Dec. 19, 2019 -
ACA's individual mandate ruled unconstitutional but key question kicked back to lower court
The long-awaited ruling is a win for Republican-led states attempting to kill the Obama-era law. States defending the ACA said they will challenge the decision.
By Samantha Liss • UPDATED: Dec. 18, 2019 at 6:39 p.m. -
Judge refuses to strike down 2020 site-neutral plan — but chides CMS
The federal judge said she lacks jurisdiction to strike down a policy yet to go into effect, but noted the agency's plans for next year disregard her earlier ruling.
By Samantha Liss • Dec. 17, 2019 -
CVS long-term care pharmacy sued by DOJ over fraudulent prescribing practices
The suit is by no means the first time the subsidiary, acquired in 2015 for about $12.7 billion, has been under the federal microscope for fraud.
By Rebecca Pifer • Dec. 17, 2019 -
Florida medical group to pay $85K for not providing medical records to patient
It's the second enforcement action against a provider in such a case by the Office for Civil Rights at HHS.
By Ron Shinkman • Dec. 16, 2019 -
HHS watchdog accuses MA plans of inflating payments by nearly $7B annually
The apparent overpayments are tied to payers tacking on new diagnosis codes as part of a review of existing medical charts, a practice CMS is encouraged to watch more closely.
By Ron Shinkman • Dec. 13, 2019 -
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
