No Surprises disputes increasing even as arbiters catch up, CMS says

The agency released new data on independent dispute resolution in the first half of 2025. Roughly 1.2 million cases were filed in that period, mostly by the same private equity-backed providers.

By Rebecca Pifer Parduhn • Jan. 26, 2026

CVS accused of shutting out rival pharmacy hubs in House Judiciary investigation

The company’s massive pharmacy benefit manager changed its rules and weaponized audits to ensure independent pharmacies couldn’t work with competing pharmacy service companies, House Republicans said.

By Rebecca Pifer Parduhn • Jan. 26, 2026

Insurance CEOs’ no good, very bad day on the Hill

The chief executives of UnitedHealth, CVS, Cigna and Elevance were pilloried for care denials, vertical consolidation and sky-high executive compensation during two House hearings Thursday.

By Rebecca Pifer Parduhn • Jan. 23, 2026

Express Scripts considering settlement in FTC insulin price lawsuit

The antitrust agency paused its lawsuit against the pharmacy benefit manager while the two discuss a proposed consent agreement.

By Emily Olsen • Jan. 23, 2026

Congress eyes tackling healthcare consolidation

“I think there’s common ground here,” one Republican congressman said Wednesday during a House Budget Committee hearing. Squaring up against healthcare monopolies would be a major pivot for the GOP.

By Rebecca Pifer Parduhn • Jan. 22, 2026

UnitedHealth pledges to return ACA profits to customers

The announcement comes one day before CEO Stephen Hemsley is set to testify on healthcare affordability in front of two congressional committees.

By Rebecca Pifer Parduhn • Jan. 21, 2026

Healthcare False Claims settlements reached record $5.7B in 2025

The healthcare fraud settlements under the False Claims Act last year more than tripled the amount from 2024.

By Sydney Halleman • Jan. 21, 2026

Medicare Advantage overpayments will total $76B this year: MedPAC

The findings are “very depressing,” one commissioner said. Still, it’s a smaller sum than in 2025, thanks to the continued phase-in of a new risk adjustment model.

By Rebecca Pifer Parduhn • Jan. 16, 2026

Hospital-at-home programs face uncertainty as another deadline looms

The Acute Hospital Care at Home Program could lapse on Jan. 30 without congressional action, creating significant administrative complexity for providers, experts say.

By Emily Olsen • Jan. 15, 2026

Trump unveils healthcare affordability plan

The “Great Healthcare Plan” is vague, but would send money directly to ACA enrollees and entrench Trump’s drug pricing deals.

By Rebecca Pifer Parduhn • Jan. 15, 2026

Kaiser affiliates to pay $556M to resolve Medicare Advantage fraud allegations

The Justice Department claims some Kaiser health plans submitted invalid diagnostic codes to reap higher reimbursement from Medicare. It’s the largest settlement linked to MA upcoding to date, according to one law firm.

By Sydney Halleman • Jan. 15, 2026

Utilization, intensity drove US health spending to $5.3T in 2024: CMS

The U.S. spent 7.2% more on healthcare in 2024. Most of the acceleration was because of greater use and intensity of medical goods and services, not growth in healthcare prices, CMS actuaries said.

By Rebecca Pifer Parduhn • Jan. 14, 2026

HHS reverses layoffs at CDC’s work safety research division

Workers at the National Institute for Occupational Safety and Health affected by the layoffs last spring received emails yesterday that their reduction-in-force notices have been revoked. Hundreds of NIOSH employees had been let go.

By Rebecca Pifer Parduhn • Jan. 14, 2026

ACA signups lag as enrollment deadline nears

Some 22.8 million people have signed up for Affordable Care Act plans through early January, slower than last year’s pace but more robust than some experts predicted. Still, the CMS data paints an incomplete picture of the market.

By Rebecca Pifer Parduhn • Jan. 13, 2026

UnitedHealth ‘aggressively’ gaming Medicare Advantage, Senate investigation finds

Staffers for Sen. Chuck Grassley, R-Iowa, dove into 50,000 pages of documentation from UnitedHealth for the new report, which accuses the company of maintaining a workforce dedicated to upcoding.

By Rebecca Pifer Parduhn • Jan. 12, 2026

Powerful PBM lobby names new CEO

David Marin will become president and chief executive of the Pharmaceutical Care Management Association effective Jan. 30.

By Rebecca Pifer Parduhn • Jan. 9, 2026

House votes to revive enhanced ACA subsidies

The House voted 230-196 to extend the financial assistance, which lapsed on Dec. 31, for three years. The measure is not expected to pass the Senate.

By Rebecca Pifer Parduhn • Jan. 8, 2026

FDA exempts more wearable, AI features from oversight

The regulator clarified the types of wellness features and clinical decision support tools that don’t fall under medical device oversight in a pair of new guidance documents.

By Elise Reuter • Jan. 8, 2026

Top healthcare provider trends in 2026

Health systems that address costs, workforce planning and portfolio strategy may be better positioned as reimbursement headwinds intensify this year.

By Michael Brady • Jan. 8, 2026

Provider, telehealth groups urge Congress to make telehealth flexibilities permanent

Piecemeal extensions of Medicare coverage for virtual services have impeded access to care, the American Medical Association argued. The policies could expire again on Jan. 30.

By Emily Olsen • Jan. 7, 2026

CDC, following Trump’s orders, weakens US stance on childhood vaccinations

In a drastic decision made outside of its typical review process, the agency declared it would recommend 11 childhood shots going forward, down from 17.

By Delilah Alvarado • Jan. 6, 2026

Ōura’s Ricky Bloomfield proposes new regulatory pathway for wearable health features

The chief medical officer is interested in an easier path to market for health screening features in wearable devices.

By Elise Reuter • Jan. 5, 2026

DEA, HHS extend telehealth controlled substance prescribing flexibilities for fourth time

The extension, released shortly before the flexibilities were set to expire at the end of 2025, gives regulators more time to finish permanent policies, the agencies said.

By Emily Olsen • Jan. 5, 2026

340B rebate pilot remains on hold in win for hospitals

The First Circuit upheld a district court’s pause of the controversial pilot on Wednesday. It’s a setback for the Trump administration, which — urged by drugmakers — wants to reshape 340B’s payment structure.

By Rebecca Pifer Parduhn • Updated Jan. 8, 2026

CMS distributes rural health funds for 2026

States received an average of $200 million to expand rural care access. Texas received the most money, while New Jersey received the least.

By Sydney Halleman • Jan. 5, 2026