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J&J sues federal government for halting 340B rebate plan
The New Jersey-based drugmaker is trying to get the courts’ backing to pay hospitals rebates for two drugs in the 340B drug discount program, instead of offering upfront discounts.
By Rebecca Pifer Parduhn • Nov. 13, 2024 -
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DOJ sues to block UnitedHealth’s $3.3B buy of home health firm Amedisys
The DOJ’s complaint is intentionally broad to maximize its chances of success, according to one expert. Still, the incoming Trump administration could throw cold water on the challenge.
By Rebecca Pifer Parduhn • Nov. 12, 2024 -
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TrendlineSurprise 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 -
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Many hospitals still aren’t complying with price transparency rule: OIG
In a sample of 100 hospitals, 34 didn’t meet requirements for publishing machine-readable files of their charges while 14 didn’t follow rules to post shoppable services.
By Emily Olsen • Nov. 12, 2024 -
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MedPAC backs tying physician pay to inflation, but ducks specifics
During a meeting Thursday, commissioners debated different solutions to lackluster physician pay with one theme in common: linking doctors’ annual payment update to the Medicare Economic Index.
By Rebecca Pifer Parduhn • Nov. 8, 2024 -
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HHS settles 2 ransomware investigations as attacks rise
The settlements mark the sixth and seventh healthcare ransomware enforcement actions from regulators.
By Emily Olsen • Nov. 7, 2024 -
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How the healthcare industry is reacting to a second Trump term
Donald Trump’s first term as president was characterized by significant turbulence for government healthcare programs. Here’s how some of the most influential industry groups responded to the Republican’s reelection.
By Rebecca Pifer Parduhn • Nov. 7, 2024 -
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MACPAC calls for greater transparency amid steep rise in Medicaid directed payments
Dramatic growth in an opaque Medicaid funding mechanism is exacerbating concerns about the program’s fiscal integrity — while spurring financial gains for the hospital industry.
By Rebecca Pifer Parduhn • Nov. 5, 2024 -
Photo illustration: Industry Dive; Joe Readle/Getty Images; Brandon Bell/Getty Images
As presidential election looms, disparate approaches to cyber policy come into focus
Government officials and security leaders are hoping the nation’s need for cyber resilience will transcend partisan politics regardless of the election results.
By David Jones • Nov. 5, 2024 -
Elise Reuter/Healthcare Dive
Michelle Tarver faces challenges as new CDRH leader. But patient groups, industry are optimistic.
Tarver is taking over as director of the Center for Devices and Radiological Health as the regulator grapples with questions around artificial intelligence in medical devices and racial bias in pulse oximeters.
By Elise Reuter • Nov. 4, 2024 -
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Elevance Health sues HHS over Medicare Advantage star ratings
The payer joins several other insurers suing federal regulators over the 2025 quality ratings, which Elevance argues will cost it at least $375 million in bonus payments and rebates.
By Emily Olsen • Nov. 4, 2024 -
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Physicians, hospitals decry 2025 Medicare payment rates
Physicians will see their Medicare reimbursement fall 2.9% next year if Congress doesn’t stop the cuts. Meanwhile, reimbursement for hospital outpatient departments is rising 2.9%.
By Rebecca Pifer Parduhn • Nov. 4, 2024 -
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Medicare saves record $2.1B from largest accountable care program
Citrus ACO in Central West Florida had the highest savings rate, while Health Connect Partners — an ACO operated by hospital giant Providence — had the highest total savings in the Medicare Shared Savings Program last year.
By Rebecca Pifer Parduhn • Oct. 31, 2024 -
Retrieved from Crozer Health.
Pennsylvania attorney general sues Prospect Medical alleging ‘corporate greed’
The lawsuit argues Prospect broke the terms of its agreement to purchase Pennsylvania system Crozer Health and seeks to stop the hospital operator from closing more facilities.
By Susanna Vogel • Oct. 31, 2024 -
FDA
Deep Dive5 steps to navigate the FDA’s new lab developed test rule
Laboratories face a series of upcoming deadlines to comply with stricter FDA oversight of in-house tests. Here are five strategies labs can take to be ready.
By Susan Kelly • Oct. 28, 2024 -
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State Medicaid directors concerned about program’s stability: KFF
The presidential election, loss of higher federal funding, inflationary pressures and other challenges are leaving state regulators uncertain about Medicaid’s “new normal.”
By Rebecca Pifer Parduhn • Oct. 24, 2024 -
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Insurer lobby blames government policies for 2025 Medicare Advantage market makeup
The Better Medicare Alliance is warning of disruptions to care for America’s seniors, though MA premiums and major benefits are essentially unchanged next year.
By Rebecca Pifer Parduhn • Oct. 23, 2024 -
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Centene sues HHS over Medicare Advantage star ratings fall
Centene is emulating other insurers unhappy with how regulators handled quality ratings for 2025. The flurry of complaints is “symptomatic of what appear to be systemic issues” with CMS calculations, Centene said.
By Rebecca Pifer Parduhn • Oct. 23, 2024 -
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Humana sues HHS over calamitous Medicare Advantage star ratings decrease
It’s the latest in a string of lawsuits from health insurers scrambling to protect their prized quality scores and the money those ratings represent.
By Rebecca Pifer Parduhn • Oct. 21, 2024 -
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Senate report slams Medicare Advantage insurers for using predictive technology to deny claims
UnitedHealth, CVS and Humana used technology to increase MA prior authorization denials for post-acute services, boosting profits, according to a report from a Senate subcommittee.
By Susanna Vogel • Oct. 21, 2024 -
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FDA outlines new Drug Supply Chain Security Act exemptions
Several groups have been granted additional time to comply with the more than 10-year-old legislation, which requires complete end-to-end supply chain visibility for pharmaceutical products.
By Kelly Stroh • Oct. 14, 2024 -
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FTC increases premerger reporting requirements over provider objections
Companies will be required to disclose more information about minority investors and past M&A activity. Provider groups said the new requirements would be burdensome for hospitals.
By Susanna Vogel • Oct. 14, 2024 -
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Opinion
When managing a healthcare practice, what’s the value of prevention?
Here are the legal issues providers need to know as litigation increases around healthcare fraud and abuse, according to two experts.
By Nadia de la Houssaye and Donald W. Washington • Oct. 10, 2024 -
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UnitedHealth, CVS push to remove FTC Chair Lina Khan from PBM case
Attorneys argue Khan and two other commissioners are biased against pharmacy benefit managers and should recuse themselves from an ongoing lawsuit against the middlemen.
By Emily Olsen • Oct. 10, 2024 -
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Overturning of Roe v. WadeSupreme Court declines to weigh in on Texas emergency abortion case
It’s a loss for the Biden administration, which has tried to require states to provide abortions for emergency care since Roe v. Wade was overturned.
By Sydney Halleman • Oct. 9, 2024 -
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Deep DiveThe number of AI medical devices has spiked in the past decade
The FDA has authorized nearly 1,000 medical devices with artificial intelligence features as companies including GE Healthcare and Siemens Healthineers build out their AI efforts.
By Elise Reuter , Jasmine Ye Han • Oct. 9, 2024
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