CMMI teases new behavioral, maternal health models launching this year

The timeline of the two upcoming models could be pushed back if Congress doesn’t come to a funding agreement and the government shuts down, CMMI head Liz Fowler said.

By Rebecca Pifer Parduhn • Sept. 15, 2023

PBM reforms in Congress would have modest effect at best and backfire at worst, Brookings says

Congress is inching closer to pharmacy benefit manager reform with new legislation released last week. But even eliminating all PBM profits would barely move the needle on U.S. drug spending, according to a new report.

By Rebecca Pifer Parduhn • Sept. 13, 2023

Lawmakers introduce bipartisan legislation addressing workplace violence in hospitals — again

Despite widespread support from healthcare workers and hospital associations, federal regulations protecting hospital workers have previously failed to advance in Congress.

By Susanna Vogel • Sept. 13, 2023

CDC endorses new COVID boosters as focus turns to rollout

Agency advisers voted 13-1 to recommend the updated shots for everyone over the age of 6 months, greenlighting the vaccines’ rollout one day after the FDA’s approval.

By Delilah Alvarado • Sept. 13, 2023

Low-income seniors more likely to report fraudulent marketing from private Medicare plans

The Commonwealth Fund survey comes after regulators finalized a rule this spring aiming to cut back on deceptive and misleading advertising for Medicare Advantage plans after beneficiary complaints rose.

By Emily Olsen • Sept. 12, 2023

L.A. Care to pay $1.3M to settle potential HIPAA breach violations

The settlement comes after state regulators levied a $55 million fine against the health plan last year for alleged operational deficiencies, including failure to address a backlog of over 9,000 prior authorization requests.

By Sydney Halleman • Sept. 12, 2023

Indiana hospital settles suit over 2021 data breach, will pay $250K

The state alleged the hospital knew about security issues before the attack and failed to directly notify patients for more than 200 days.

By Emily Olsen • Sept. 11, 2023

Kaiser Permanente to pay $49M after investigators found syringes, medical records in trash

The settlement concludes an eight-year investigation, during which investigators reviewed dumpster contents and found “hundreds of items” of hazardous waste and paper records containing patient health information.

By Susanna Vogel • Sept. 11, 2023

MA enrollment in rural areas nearly quadrupled since 2010, KFF finds

More rural seniors are turning to Medicare Advantage, but the plans can offer limited provider networks. That could prove an additional challenge for rural beneficiaries who already have to travel further distances for care.

By Emily Olsen • Sept. 8, 2023

Medical credit cards ‘exploit loopholes’ in healthcare debt protection, report finds

The credit cards, which can promise patients deceptive no- or low-interest rates, are increasingly being offered in hospitals and physician offices.

By Sydney Halleman • Sept. 8, 2023

Unionized nursing homes more likely to report workplace injuries and accidents

Only 40% of nursing homes nationwide complied with reporting requirements between 2016 and 2021, despite nursing homes being among the most dangerous workplaces in America, according to the Health Affairs study.

By Susanna Vogel • Sept. 7, 2023

Astellas withdraws lawsuit challenging Medicare drug price program

Contrary to the drugmaker’s expectations, its top-selling cancer medicine Xtandi wasn’t picked as one of the first 10 drugs to face price negotiations.

By Ned Pagliarulo • Sept. 7, 2023

‘Revolving door’ between HHS and industry could influence regulation, study says

Thirty-two percent of people appointed to positions at the HHS between 2004 and 2020 exited to the private sector, raising concerns about objectivity, according to new research.

By Emily Olsen • Sept. 7, 2023

FDA proposes 3 guidances to improve 510(k) clearance process

The agency has made recommendations for selecting predicate devices, using clinical data and conducting performance testing for implants.

By Nick Paul Taylor • Sept. 7, 2023

MA plans were overpaid $9.3B annually from 2017 to 2020, study finds

Favorable selection of healthier beneficiaries led to overpayments in counties with high Medicare Advantage penetration, but benchmark changes could mitigate the impact.

By Emily Olsen • Sept. 6, 2023

CMS creates all-payer funding opportunity for states

Regulators' latest effort to nudge the U.S. away from fee-for-service takes a page from how Maryland pays its hospitals.

By Rebecca Pifer Parduhn • Sept. 6, 2023

Humana sues HHS over Medicare Advantage audits

The payer, which brings in the bulk of its revenue from Medicare, is fighting a rule finalized earlier this year to claw back overpayments in the increasingly popular MA program.

By Rebecca Pifer Parduhn • Sept. 5, 2023

Biden administration proposes landmark nursing home staffing minimums

The controversial proposal would require nursing homes to have a registered nurse on site 24/7 and have three hours of care per resident per day. 

By Susanna Vogel • Sept. 1, 2023

ONC taps Sequoia Project as TEFCA overseer, again

The nonprofit will receive $2 million in funding from the government in the first year of its new five-year contract for managing the interoperability network.

By Rebecca Pifer Parduhn • Aug. 31, 2023

Prisma Health files suit against UnitedHealthcare, alleging ‘bad faith’ contract negotiation tactics

The South Carolina-based health system alleges that the insurer broke its contract and gave "false and misleading" statements to the press about Prisma’s proposed rates for 2024.

By Susanna Vogel • Aug. 31, 2023

Medicaid cracks down on states over children wrongly losing coverage during redeterminations

The Biden administration is threatening state Medicaid agencies with sanctions after finding an automation glitch that could cause eligible children to lose coverage.

By Rebecca Pifer Parduhn • Aug. 31, 2023

Medicare names first 10 drugs for price negotiations

The list includes the top-selling blood thinners Eliquis and Xarelto, as well as the arthritis drug Enbrel and heart failure medicine Entresto.

By Ned Pagliarulo • Updated Aug. 29, 2023

Texas judge rules to vacate more No Surprises Act regulations

The ruling, which targets guidance related to the independent dispute resolution process, prompted the CMS to again pause all federal disputes.

By Sydney Halleman • Aug. 28, 2023

‘Project NextGen’ to spend $1.4B in search for better COVID drugs, vaccines

Inspired by Operation Warp Speed, the new federal program aims to fund development and testing of new therapies that can stay ahead of an evolving virus.

By Ben Fidler • Aug. 25, 2023

KFF report explores cost, antitrust implications for cross-market hospital mergers

Regulating cross-market mergers will be “on the radar” of policymakers and regulators as they become increasingly common, the report noted.

By Susanna Vogel • Aug. 25, 2023