Government: Page 11

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    Judge dismisses Humana’s Medicare Advantage star ratings suit

    It’s a significant loss for the insurer, which sued the government late last year after its star ratings plummeted for 2025. Analysts estimate Humana could lose billions of dollars as a result of the decision.

    By • Updated July 18, 2025
  • President-elect Donald Trump, wearing a MAGA hat, and Dr. Oz shake hands as Oz exits a stage.
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    Trump administration to end Medicaid waivers for continuous enrollment, workforce training

    On Thursday, CMS sent letters to states notifying them that it doesn’t plan to approve any new such waivers or extend existing ones in the administration’s latest curtailing of Medicaid.

    By • July 18, 2025
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    Ned Pagliarulo/Healthcare Dive
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    33 states pick up CMS program to pay for sickle cell gene therapies

    States representing about 84% of Medicaid beneficiaries are participating in an initiative that enables the government to negotiate pay-for-performance deals with the manufacturers of products like Casgevy and Lyfgenia.

    By Ben Fidler • July 16, 2025
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    Leigh Vogel via Getty Images
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    Medicaid cuts could have ‘far-reaching’ healthcare, economic impacts: study

    Coverage losses linked to the massive tax and policy law could drive up excess deaths and preventable hospitalizations by 2034, according to the study in JAMA Health Forum.

    By • July 16, 2025
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    Alex Wong via Getty Images
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    Medicare targets site neutrality, price transparency in hospital outpatient rule

    The proposed rule would send an additional $8 billion to hospitals next year, but includes a number of other policies hospital groups have criticized.

    By , • July 16, 2025
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    Judge nixes Biden-era rule removing medical debt from credit reports

    It’s a victory for the credit reporting industry and a loss for advocates of reducing medical debt. The Trump administration had declined to defend the rule in court.

    By • July 15, 2025
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    Alex Wong via Getty Images
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    CMS proposes rule aligning Medicare physician payment with ‘Big Beautiful Bill,’ MACRA

    The sweeping regulation proposes notable changes to how Medicare pays physicians, but overall results in a modest bump to reimbursement in 2026.

    By • July 15, 2025
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    CMS proposes covering renal denervation for hypertension

    The proposed determination recommends Medicare coverage for both radiofrequency- and ultrasound-based renal denervation.

    By Susan Kelly • July 11, 2025
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    Alignment Healthcare wins partial victory in Medicare Advantage star ratings case

    A judge agreed that the CMS should recalculate the scores for one Alignment plan in Arizona. Now, all of the insurer’s MA members are in plans rated four stars or higher.

    By • July 10, 2025
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    CVS Omnicare ordered to pay $949 million in government fraud case

    CVS plans to appeal the judgment, which comes after a jury ruled that its long-term care pharmacy benefits manager illegally charged Medicare, Medicaid and Tricare for prescription drugs for almost a decade.

    By • July 9, 2025
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    Courtesy of Thermo Fisher Scientific
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    Deep Dive

    The Trump administration wants to onshore drug manufacturing. Technologists are answering the call.

    Looming threats to the pharmaceutical supply chain have brought fresh attention to onshoring. Experts say innovation is happening, but slowly.

    By Susanna Vogel • July 9, 2025
  • A woman walks in front of a sign by a Planned Parenthood health center on June 26, 2025 in San Rafael, California.
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    Judge temporarily blocks megabill’s Planned Parenthood Medicaid funding ban

    The restraining order prevents the Trump administration from enacting a provision of the massive tax and policy law that would cut Medicaid funding for Planned Parenthood.

    By • July 8, 2025
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    Court orders HHS to restore webpages related to ‘gender ideology’

    A federal judge ordered the government to reinstate critical documents as soon as possible, but left the door open for the Trump administration to take a second crack at removing the data.

    By Susanna Vogel • July 8, 2025
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    Medical groups, pregnant doctor sue RFK Jr. over vaccine changes

    The complaint argues Kennedy’s actions to remove the COVID vaccine from the CDC's immunization schedule for pregnant people and healthy children were unlawful.

    By • Updated July 8, 2025
  • President Donald Trump speaks to reporters with Speaker of the House Mike Johnson.
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    Historic Medicaid cuts to come as Trump signs domestic policy bill

    President Donald Trump passed the GOP's tax megabill into law, setting into motion $1 trillion in Medicaid cuts despite objections from hospitals, doctors, insurers and other stakeholders in the healthcare industry.

    By • July 4, 2025
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    Alex Wong via Getty Images
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    Deep Dive

    340B could have a new cop on the beat. Hospitals are worried.

    The HHS wants to move oversight of the controversial drug discount program to the CMS, which has a more aggressive history with 340B than its covered providers would prefer. “It could be truly devastating,” one expert said.

    By • July 2, 2025
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    DOJ charges more than 300 in $14.6B healthcare fraud bust

    Matthew Galeotti, head of the Justice Department’s criminal division, called the operation “the beginning of a new era of aggressive prosecution and data-driven prevention” of healthcare fraud.

    By Susanna Vogel • July 1, 2025
  • U.S. Senate Majority Leader John Thune (R-S.D.) speaks to reporters after walking off the Senate floor at the US Capitol Hill on June 29 in Washington, D.C. Senate Republicans worked overnight, forced by Democrats to read a new version of the "One, Big, Beautiful Bill," as they approach President Donald Trump's July 4 deadline.
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    Senate passes Trump’s spending bill with massive Medicaid cuts

    After a marathon “vote-a-rama,” the Senate narrowly passed the legislation 51-50, with Vice President JD Vance casting the tiebreaking vote.

    By , Susanna Vogel • Updated July 2, 2025
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    CMMI to add prior authorization for some Medicare services

    Beginning next year, the CMS will launch an AI-powered prior authorization process for some services as it seeks to cut funding for what it deems medically unnecessary care.

    By Susanna Vogel • July 1, 2025
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    FDA stops Olympus devices from entering the US

    The agency said it issued the import alerts because it “continues to have concerns related to outstanding Quality System regulation violations by Olympus.”

    By Nick Paul Taylor • June 30, 2025
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    Caroline Colvin/Healthcare Dive
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    Supreme Court allows states to cut Medicaid funding for Planned Parenthood

    The judgment comes in a dispute over a South Carolina policy, but is expected to have sweeping implications nationwide. 

    By Susanna Vogel • June 30, 2025
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    Supreme Court upholds ACA preventive services mandate

    The high court preserved a key portion of the Affordable Care Act that requires private insurers to cover a range of preventive healthcare services without cost sharing.

    By • June 27, 2025
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    Congress should reconsider breaking up pharmacy benefit managers, experts say

    Many popular proposals to reform the PBM industry are missing the forest for the trees, drug market experts said in Washington, D.C. Instead, Congress should go after the root issue: the oligopoly enjoyed by the Big Three PBMs.

    By • June 27, 2025
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    CVS Caremark to pay $95M in Medicare fraud case

    A federal judge ruled in favor of a whistleblower, finding CVS’ pharmacy benefit manager Caremark overbilled Medicare for generic drugs.

    By • June 26, 2025
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    CDC panel, newly remade by RFK Jr., questions vaccine evidence

    New members of the ACIP panel raised questions about the evidence supporting COVID vaccines, and signaled plans to look at other established shots, like those for measles and hepatitis B.

    By • June 25, 2025