Shared Savings ACOs saved Medicare $1.8B in 2022

Nearly two-thirds of participating accountable care organizations earned payments for their performance last year, according to the CMS.

By Emily Olsen • Aug. 25, 2023

HHS agency launches project to boost healthcare cybersecurity

The Advanced Research Projects Agency for Health is soliciting proposals for a project that would repurpose national security tech to protect the healthcare industry from cyberattacks.

By Emily Olsen • Aug. 24, 2023

CMS threatens to cut hospices from Medicare if they can’t prove legitimacy

The crackdown comes after media reports found fraudulent activity in hospice facilities, including those that certified patients for care who were not terminally ill and those that ran “churn and burn” billing schemes.

By Susanna Vogel • Aug. 24, 2023

MA beneficiaries like their plans, but few say it’s easy to find care

Trust and the ability to resolve problems or complaints were factors most highly correlated with members’ likelihood of renewing their plans, according to a new J.D. Power study.

By Emily Olsen • Aug. 23, 2023

Pandemic relief funds bolstered operating margins at vulnerable hospitals, Health Affairs finds

The funds have come under scrutiny, with some reports suggesting that high-performing hospitals capitalized on them to post record operating margins.

By Susanna Vogel • Aug. 23, 2023

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 Parduhn • 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

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 Parduhn • 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 Parduhn • 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 Parduhn • 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 Parduhn • 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 Parduhn • 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 Parduhn • 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 Parduhn • 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 Parduhn • 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 Parduhn • July 28, 2023