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

Explore the Trendline➔

Surprise 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

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

CMS says data of 612K Medicare beneficiaries affected in MoveIt breach

A data breach earlier this year has affected tens of millions of individuals to date, and also compromised the sensitive personal and medical information of Medicare seniors.

By Rebecca Pifer Parduhn • July 28, 2023

FTC reaches proposed settlement with Surescripts in antitrust case

The lawsuit alleged the health IT vendor monopolized e-prescription drug markets for routing and eligibility through exclusivity agreements, threats and other exclusionary conduct.

By Emily Olsen • July 28, 2023

Nevada to shut down Friday Health Plans

State regulators will liquidate the failing insurtech, leaving about 3,000 enrollees to look for new coverage.

By Emily Olsen • July 27, 2023

Cleveland sues major PBMs, drug manufacturers over rising insulin prices

The suit argues that PBMs, including CVS Caremark, Express Scripts and OptumRx, use their market power to drive up the cost of insulin for Cleveland residents — approximately 17% of whom are diabetic. 

By Sydney Halleman • July 26, 2023

Biden administration cracks down on payers over mental health coverage

A new proposed rule from the HHS and Treasury and Labor departments would require health insurers to analyze patient outcomes to ensure their benefits are administered equally.

By Rebecca Pifer Parduhn • July 25, 2023

New antitrust merger guidelines could have significant chilling effect on healthcare deals

Regulators have historically struggled to make a case against complex and non-traditional tie-ups. That could change with the new guidelines.

By Rebecca Pifer Parduhn • July 21, 2023

Prior authorization denials could limit access in Medicaid managed care, OIG reports

Medicaid managed care organizations denied one out of every eight requests for prior authorization in 2019, and most states don’t regularly monitor if denials are appropriate, the HHS’ Office of the Inspector General found.

By Emily Olsen • July 20, 2023

CMS pausing Medicaid redeterminations in states noncompliant with renewal requirements

The Biden administration is cracking down on states in an effort to curb rampant procedural disenrollments from the safety-net program.

By Rebecca Pifer Parduhn • July 20, 2023

Colorado to shut down failing Friday Health Plans

State regulators had initially hoped the insurtech could operate for the rest of the year, but Colorado’s insurance division became concerned about Friday’s longevity after placing the insurer into rehabilitation.

By Emily Olsen • July 18, 2023

FTC withdraws ‘outdated’ antitrust policy statements. Hospitals cry foul.

Hospital groups said they were deeply disappointed with the decision, which removes a guidepost for those looking to consolidate without attracting the ire of regulators.

By Rebecca Pifer Parduhn • July 18, 2023

EHR vendor NextGen to pay $31 million to settle False Claims Act allegations

The settlement comes after the Supreme Court in June ruled that FCA defendants are liable for claims they suspect or knowingly believe are false.

By Brian T. Horowitz • July 17, 2023

CMS floats 1.25% physician fee cut, 2.8% outpatient bump in new proposed rules

Regulators also proposed stricter price transparency requirements on hospitals and expanded behavioral health payments in Medicare.

By Sydney Halleman • July 14, 2023

Kraft Heinz sues Aetna, says insurer breached ERISA fiduciary duties

Aetna wrongly retained millions in undisclosed fees and paid provider claims “that should have never been paid,” according to the lawsuit filed in a Texas federal court.

By Ryan Golden • July 13, 2023

States’ varying approaches complicate effort to determine impact of Medicaid redeterminations

Millions of people have been disenrolled from Medicaid, but it’s too early to get a full picture of redeterminations’ effect on vulnerable Americans, experts say.

By Emily Olsen • July 13, 2023

First nonprescription birth control pill approved by FDA

The oral contraceptive’s maker, Perrigo, said the pill will be available in drug and grocery stores early next year, but did not disclose its planned price.

By Delilah Alvarado • July 13, 2023

CFPB urged to abolish deferred interest amid medical debt concerns

Panelists who spoke during a recent hearing on medical billing and collections identified deferred interest credit cards as a prime culprit saddling patients with medical debt.

By Caitlin Mullen • July 13, 2023

CMS faces poor data quality in payment model health equity push

Variable race and ethnicity data is making it difficult to determine whether CMS Innovation Center models are reaching, enrolling and helping underserved beneficiaries, according to a new white paper from the agency.

By Rebecca Pifer Parduhn • July 12, 2023

Feds drill down on medical cards

With consumers increasingly tapping medical credit cards to pay for healthcare costs, the Biden administration is zeroing in on regulations to police such financial services.

By Lynne Marek • July 10, 2023

Judge throws out class action lawsuit against Teladoc

A New York judge ruled that Teladoc had detailed risks of its $18 billion Livongo acquisition and that, while the company may have been optimistic regarding its operations, it did not falsify facts or statements.

By Brian T. Horowitz • July 10, 2023

CMS to return $9B to 340B hospitals under new plan

Hospital groups said the proposed rule is an important step toward restitution for years of 340B underpayments, but they criticized regulators for proposed rate decreases and a lack of additional interest payments.

By Rebecca Pifer Parduhn • July 10, 2023

Home health industry group sues CMS, HHS over payment cuts

The National Association for Home Care and Hospice said regulators used “an illogical and invalid methodology” in a new payment model.

By Emily Olsen • July 7, 2023

Biden admin rolls back Trump-era expansion of short-term health plans

The proposed rule released Friday would limit short-term plan duration to up to four months. Stakeholders have been waiting for President Joe Biden to restrict access to the bare-bones coverage since he assumed office.

By Rebecca Pifer Parduhn • July 7, 2023