Florida sued over Medicaid redeterminations

Three Floridians, including two children, filed a lawsuit against the state on Tuesday alleging it illegally cut their Medicaid coverage without proper notice.

By Rebecca Pifer • Aug. 23, 2023

Boehringer sues to block US drug price program

The pharma’s suit, which claims Medicare’s new power to negotiate certain drug prices is unconstitutional, comes days before the agency will reveal the first 10 medicines to be included under the plan.

By Ned Pagliarulo • Aug. 22, 2023

Explore the Trendline➔

Surprise Billing

Federal legislation banning surprise bills has hit a barrage of roadblocks, complicating efforts to protect consumers from unexpected out-of-network charges.

By Healthcare Dive staff

Minnesota AG launches investigation into Allina Health’s billing practices

Allina Health will "formally transition away” from its policy of interrupting non-emergency, outpatient care for patients with debt, a spokesperson said. The announcement will not affect the Minnesota investigation.

By Susanna Vogel • Updated Aug. 23, 2023

Ground ambulance billing committee skeptical of IDR process

A key congressional advisory group met last week to deliberate preventing unexpected bills after medical transport, but said the status quo dispute resolution process isn’t the solution.

By Rebecca Pifer • Aug. 17, 2023

Appeals court rules to limit abortion pill access

Federal judges disagreed with a lower court decision suspending the pill’s approval, but said recent changes that loosened prescribing rules should be rolled back.

By Delilah Alvarado • Aug. 16, 2023

CMS tweaks ACO REACH to stabilize model

Regulators lowered enrollment minimums for accountable care organizations in the program, which allows providers to form groups to manage care and costs for fee-for-service Medicare enrollees.

By Rebecca Pifer • Aug. 15, 2023

Will the Biden administration’s short-term plan rule increase the uninsured rate?

Free-market advocates argue proposed restrictions on short-term plans will leave consumers without coverage. Health policy researchers aren’t so sure.

By Rebecca Pifer • Aug. 14, 2023

DOJ hits UnitedHealth, Amedisys with second request over $3.3B deal

The request for more information pushes back the timeline of the merger as regulators take a more active stance in healthcare M&A oversight.

By Rebecca Pifer • Aug. 11, 2023

HHS pledges more than $100M to grow nursing workforce

The investment aims to reduce bottlenecks in nurse training that stakeholders say hamper recruitment efforts.

By Susanna Vogel • Aug. 10, 2023

MA bonuses reach record high, with UnitedHealthcare, Humana biggest winners

Star ratings bonuses reached $12.8 billion, according to the KFF, as the Medicare program faces a growing spending crisis.

By Rebecca Pifer • Aug. 10, 2023

Senators crack down on nonprofit hospitals’ charity care, tax-exempt status

The letter, sent by a bipartisan group of senators to tax commissioners, comes as the federal government increases scrutiny into nonprofit hospitals’ charity care spending.

By Sydney Halleman • Aug. 9, 2023

Texas judge rules in favor of doctors in latest suit over surprise billing process

The decision is expected to increase the number of claims providers file in the independent dispute resolution process, especially for smaller amounts, according to a health lawyer.

By Rebecca Pifer • Aug. 7, 2023

DEA open to considering special registration for telehealth controlled substance prescriptions

The announcement comes after the agency received more than 38,000 public comments in response to a proposal that would restrict telehealth prescriptions, with “a significant majority” expressing concern.

By Emily Olsen • Aug. 7, 2023

FDA approves Sage, Biogen drug for postpartum depression, but rejects wider use

The approval of Zurzuvae marks the first time the FDA has approved a pill for postpartum depression.

By Jacob Bell • Aug. 5, 2023

Health insurers ignore surprise billing decisions, providers allege

Payers didn’t reimburse doctors in more than half of arbitration award cases, according to a survey from clinician group Americans for Fair Health Care.

By Rebecca Pifer • Aug. 4, 2023

Kentucky sues major PBMs over rising insulin prices

A string of states and cities have filed recent suits against PBMs and drug manufacturers alleging they work in tandem to raise the cost of insulin.

By Sydney Halleman • Aug. 4, 2023

UnitedHealth unit sued by Labor Department over systematic claims denials

The government is alleging plan administrator UMR improperly denied thousands of ER and drug screening claims submitted between 2015 and 2018.

By Susanna Vogel • Aug. 2, 2023

CMS finalizes 3.1% inpatient payment bump for hospitals

Hospitals decried the rate adjustment, which is higher than the 2.8% proposed earlier this year, as out of touch with their financial reality.

By Rebecca Pifer • Aug. 2, 2023

Hospital, payer lobbies urge CMS to reconsider ‘conflicting’ prior authorization standards

The groups, normally at odds, have found a source of agreement in proposed rules meant to standardize data exchange processes.

By Brian T. Horowitz • July 31, 2023

CMS releases April Medicaid unwinding data. Total disenrollments top 3.8M

The highly-anticipated data pegging the nation’s procedural disenrollment rate at 80% is higher than more recent estimates.

By Rebecca Pifer • July 28, 2023

CMS says data of 612K Medicare beneficiaries affected in MoveIt breach

A data breach earlier this year has affected tens of millions of individuals to date, and also compromised the sensitive personal and medical information of Medicare seniors.

By Rebecca Pifer • July 28, 2023

FTC reaches proposed settlement with Surescripts in antitrust case

The lawsuit alleged the health IT vendor monopolized e-prescription drug markets for routing and eligibility through exclusivity agreements, threats and other exclusionary conduct.

By Emily Olsen • July 28, 2023

Nevada to shut down Friday Health Plans

State regulators will liquidate the failing insurtech, leaving about 3,000 enrollees to look for new coverage.

By Emily Olsen • July 27, 2023

Cleveland sues major PBMs, drug manufacturers over rising insulin prices

The suit argues that PBMs, including CVS Caremark, Express Scripts and OptumRx, use their market power to drive up the cost of insulin for Cleveland residents — approximately 17% of whom are diabetic. 

By Sydney Halleman • July 26, 2023

Biden administration cracks down on payers over mental health coverage

A new proposed rule from the HHS and Treasury and Labor departments would require health insurers to analyze patient outcomes to ensure their benefits are administered equally.

By Rebecca Pifer • July 25, 2023