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CMS to increase oversight on exchange brokers
The agency has reported a growing number of complaints about ACA health plan applications submitted by brokers.
By Emily Olsen • Oct. 7, 2024 -
Courtesy of UnitedHealth Group
UnitedHealth sues CMS over Medicare Advantage star ratings
A handful of plans owned by the nation's largest MA payer are the latest to ask the court to help raise their valuable quality scores.
By Rebecca Pifer Parduhn • Oct. 4, 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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Texas sues major PBMs, pharma companies over high insulin prices
The litigation comes as pharmacy benefit managers Express Scripts, CVS Caremark and Optum Rx face growing criticism over their role in high drug costs — including a recent lawsuit from the Federal Trade Commission.
By Emily Olsen • Oct. 4, 2024 -
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CMS should take stronger stance on hospital pricing compliance: GAO
The CMS fails to check hospitals’ pricing data for accuracy and completeness, raising questions about whether the data can be used as intended to help payers and patients shop for services, according to the government agency.
By Susanna Vogel • Oct. 4, 2024 -
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Lawmakers urge Biden administration to extend telehealth prescribing flexibilities for opioid use disorder
A bipartisan group of two dozen representatives pushed officials to preserve the pandemic-era prescribing changes for buprenorphine, arguing telehealth increases access and prevents overdoses.
By Emily Olsen • Oct. 3, 2024 -
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Medicare tweaks rules for second round of drug price talks
The agency will offer earlier meetings with drugmakers as well as solicit more patient feedback on the process.
By Ned Pagliarulo • Oct. 3, 2024 -
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Humana’s Medicare Advantage dilemma worsens amid precipitous drop in 2025 star ratings
Only 25% of Humana members will be in plans with four stars or above next year, down from 94% this year, the insurer disclosed last week. The downgrade could wipe out Humana’s profits in 2026.
By Rebecca Pifer Parduhn • Oct. 3, 2024 -
Illustration: Xavier Lalanne-Tauzia for Industry Dive
CHS offloads two North Carolina hospitals to Iredell Health
The sale offers a lifeline for struggling Davis Regional Psychiatric Hospital, which stakeholders worried could close after CHS’ deal to sell the facility to Novant Health fell through in June.
By Susanna Vogel • Oct. 3, 2024 -
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J&J drops 340B rebate plan following government pressure
Threatened with steep sanctions and losing access to Medicare and Medicaid, Johnson & Johnson is rolling back a plan to give hospitals after-the-fact rebates for drugs in the 340B drug discount program.
By Rebecca Pifer Parduhn • Oct. 1, 2024 -
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Tracking Steward's declineSteward CEO sues senators day before he steps down
The news comes days after the Senate voted to hold Ralph de la Torre in criminal contempt for failing to comply with a congressional subpoena.
By Susanna Vogel • Sept. 30, 2024 -
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MA premiums to decrease on average in 2025
The CMS said premiums, benefits and plan choices will hold steady in 2025, even as insurers have warned they could cut MA offerings in a bid to preserve profits.
By Emily Olsen • Sept. 30, 2024 -
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OpinionThe unexpected consequences of hospital quality scores
One clinical affairs expert argues that it’s time to reexamine the federal Hospital-Acquired Condition Reduction Program.
By Alice Brewer • Sept. 27, 2024 -
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Senators introduce bill to set healthcare cybersecurity standards
The legislation, sponsored by Sens. Ron Wyden and Mark Warner, would direct the HHS to develop minimum cybersecurity standards for providers, health plans, claims clearinghouses and business associates.
By Emily Olsen • Sept. 26, 2024 -
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Democrats introduce bill to make increased ACA subsidies permanent
If the enhanced tax credits expire, healthcare costs for millions of Americans will suddenly increase, and some could become uninsured, Democrats say. But Republicans argue the subsidies are costly and create opportunities for fraud.
By Rebecca Pifer Parduhn , Emily Olsen • Sept. 26, 2024 -
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Tracking Steward's declineSenate votes unanimously to hold Steward Health Care CEO in criminal contempt
It’s the first time in more than 50 years the Senate has voted to send a contempt charge to the U.S. Department of Justice, which will determine whether to bring charges against Ralph de la Torre.
By Susanna Vogel • Updated Sept. 26, 2024 -
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Home care agency settles allegations it accommodated ‘race-based requests’ for aides
The home health aide provider allegedly terminated the assignments of Black and Hispanic aides to accommodate patients’ and family members’ racial preferences, the Equal Employment Opportunity Commission said.
By Ginger Christ • Sept. 25, 2024 -
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Remote patient monitoring in Medicare needs more oversight: OIG
Regulators say Medicare needs more data and oversight to avoid fraud and misuse. Digital health advocates argue the service is still crucial for managing chronic conditions.
By Emily Olsen • Sept. 25, 2024 -
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HHS to invest nearly $75M in rural healthcare
The funds will go toward expanding substance use disorder treatment and maternal healthcare services, as well as helping rural hospitals keep their doors open.
By Emily Olsen • Sept. 25, 2024 -
Courtesy of Food and Drug Administration
CMS holds accountable care organizations harmless for ‘highly suspect’ Medicare billing
Aberrant billing for urinary catheters last year could have made it harder for ACOs in Medicare to bring in shared savings. That’s no longer the case under a new final rule.
By Rebecca Pifer Parduhn • Sept. 25, 2024 -
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Novo CEO pressed by Senate to cut prices of obesity, diabetes drugs
CEO Lars Fruergaard Jørgensen told lawmakers the company would consider new talks with insurers about the list prices of Wegovy and Ozempic if they pledge to keep the medicines on their formularies.
By Jonathan Gardner • Sept. 25, 2024 -
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Overturning of Roe v. WadeTop Senate Democrat grills hospitals on EMTALA compliance as women denied emergency abortions
Sen. Ron Wyden, D-Ore., sent letters to eight hospitals that have reportedly refused patients emergency abortion care in potential violation of federal law.
By Rebecca Pifer Parduhn • Sept. 24, 2024 -
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Texas attorney general, generative AI company settle over accuracy allegations
The agreement resolves allegations that Pieces Technologies made deceptive claims about the accuracy of its documentation products. Pieces denied any wrongdoing.
By Emily Olsen • Sept. 23, 2024 -
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OpinionTelehealth providers at a crossroads: Navigating insurance, compliance and cash-only models amid state regulations
Providers using telehealth face an evolving landscape, and they must balance complexities around insurance, regulatory compliance and data privacy, argues one legal expert.
By Paul Schmeltzer • Sept. 20, 2024 -
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FTC sues major pharmacy benefit managers over insulin prices
The agency brought action against Caremark, Express Scripts and Optum Rx, arguing their “anticompetitive and unfair” rebating practices “artificially inflated” the list price of life-saving insulin drugs.
By Rebecca Pifer Parduhn • Updated Sept. 20, 2024 -
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House committee passes telehealth flexibility extension
The bill would extend pandemic-era telehealth flexibilities in Medicare for another two years, averting a looming year-end deadline.
By Emily Olsen • Sept. 20, 2024
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