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No Surprises implementation created uptick in in-network claims: Fair Health
From the fourth quarter of 2021 to the first quarter of 2022, in-network care as a percentage of all national claim lines increased 2.3%, the nonprofit found.
By Rebecca Pifer Parduhn • Feb. 20, 2024 -
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Telehealth services during pandemic largely compliant with Medicare, OIG finds
The latest audit from the HHS’ Office of Inspector General comes as some Medicare flexibilities for telehealth are set to expire at the end of this year.
By Emily Olsen • Feb. 16, 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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Disputes over surprise billing continue to soar, new CMS data shows
Arbiters are mostly selecting the higher payment offer in billing dispute determinations. That suggests No Surprises could actually raise premiums for consumers, one health researcher said.
By Rebecca Pifer Parduhn • Feb. 16, 2024 -
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House subcommittee grills VA, Oracle over pharmacy issues amid EHR rollout
Implementation of the new electronic health record has been rocky, with system reliability and safety concerns plaguing the Department of Veterans Affairs.
By Emily Olsen • Feb. 15, 2024 -
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Data broker used phone location info to track Planned Parenthood visits, senator says
Sen. Ron Wyden urged federal regulators to crack down on a data broker that allegedly used location data to track visits to clinics and target users with anti-abortion ads.
By Emily Olsen • Feb. 14, 2024 -
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Humana sued over alleged 340B underpayments in Medicare Advantage
Alabama-based Baptist Health argued the insurer had received a “windfall” due to illegal payment cuts in the 340B drug discount program.
By Emily Olsen • Feb. 13, 2024 -
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Washington state bill seeks to regulate hospital mergers, care access
The Washington state Senate advanced legislation Thursday that grants the state attorney authority to deny mergers that may limit healthcare access.
By Susanna Vogel • Feb. 13, 2024 -
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FTC obtains $195M judgment against Simple Health for selling ‘sham’ insurance
The Florida-based insurer deceived tens of thousands of consumers into purchasing what they believed was comprehensive coverage, but instead amounted to a medical discount membership.
By Rebecca Pifer Parduhn • Feb. 12, 2024 -
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Lawsuit accuses Advocate Aurora of charging ‘eye-watering’ prices
The lawsuit accuses the health system of using acquisitions, noncompetes and gag clauses to create a monopoly and increase prices.
By Susanna Vogel • Feb. 12, 2024 -
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Pharma CEOs, pressed by Senate panel, refuse to commit to price cuts
Forced into testifying by Senate HELP chair Bernie Sanders, the heads of Bristol Myers Squibb, J&J and Merck largely avoided major missteps.
By Jonathan Gardner • Feb. 8, 2024 -
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Senate finance committee weighs healthcare AI oversight
Lawmakers considered how to prevent artificial intelligence from worsening bias or improperly denying coverage at a Feb. 8 hearing.
By Emily Olsen • Feb. 8, 2024 -
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Q&AHHS ambassador Ty Greenhalgh on what to expect from federal cybersecurity guidance in healthcare
Ty Greenhalgh discusses what the Biden administration’s cybersecurity performance goals mean for the industry, and how they could lead to a tightening of the HIPAA Security Rule.
By Brian T. Horowitz • Feb. 8, 2024 -
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AHA calls for more payer oversight in No Surprises dispute resolution
In comments on a proposed rule, the American Hospital Association argued regulators haven’t fully addressed how they’ll handle oversight for some situations, like when an insurer fails to pay after a dispute determination.
By Emily Olsen • Feb. 7, 2024 -
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FDA panel recommends new standards for pulse oximeters amid bias concerns
Studies have found that pulse oximeters overestimated oxygen saturation in people with dark skin pigmentation, resulting in delayed care.
By Elise Reuter • Feb. 5, 2024 -
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Humana flags potential MA funding dip if proposed rate notice finalized
Despite the uncertainty, the insurer reaffirmed its earnings outlook for 2025.
By Rebecca Pifer Parduhn • Feb. 5, 2024 -
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Providence erases or refunds $158M in medical bills
The Renton, Washington-based nonprofit health system plans to spend millions to settle allegations it skirted charity care obligations between 2018 and 2023.
By Susanna Vogel • Feb. 2, 2024 -
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HHS finalizes rule on telehealth at opioid treatment programs
The rule marks the first substantial changes to treatment and delivery standards at opioid treatment programs in more than 20 years.
By Emily Olsen • Feb. 2, 2024 -
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Medicare Advantage plans could see rates dip slightly in 2025
The CMS proposed a 0.2% dip in MA rates. However, analysts said regulators will likely improve the payment rate in the final notice.
By Rebecca Pifer Parduhn • Feb. 1, 2024 -
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New CMS pilot to test payment scheme for pricey sickle cell gene therapies
The CMS innovation center will coordinate insurance coverage across states to help patients access new treatments with multi-million-dollar price tags.
By Ned Pagliarulo • Jan. 31, 2024 -
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FDA extends deadline for comments on role of digital health in diabetes detection
The agency is seeking answers on how digital health technologies could be used in the detection of prediabetes and Type 2 diabetes.
By Nick Paul Taylor • Jan. 31, 2024 -
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Medicare ACO participation grows in 2024: CMS
However, growth in Medicare's flagship shared savings model has plateaued over the past five years, according to government data.
By Rebecca Pifer Parduhn • Jan. 30, 2024 -
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FTC sues to block Novant purchase of two CHS hospitals
Regulators filed a lawsuit on Thursday to block North Carolina-based Novant Health from expanding its grip on healthcare in the state, warning a buy would increase costs.
By Susanna Vogel • Jan. 25, 2024 -
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HHS releases voluntary cybersecurity goals for the healthcare sector
The resources serve as a “step forward” as the agency looks to propose enforceable standards, HHS Deputy Secretary Andrea Palm said.
By Emily Olsen • Jan. 25, 2024 -
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Senator probes MA exchanges’ marketing tactics
The head of the Senate Finance Committee sent letters to several health insurance exchanges on Tuesday, as part of an inquiry into allegedly predatory Medicare Advantage marketing to seniors.
By Sydney Halleman • Jan. 24, 2024 -
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Tracking Steward's declineLawmakers press Steward Health Care over reports of ‘grave financial distress’
Lawmakers demanded the operator detail how it will "ensure the communities Steward’s hospitals serve are not abandoned" amid financial troubles.
By Susanna Vogel • Jan. 24, 2024
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