Major hospitals still noncompliant with price transparency rules

No hospitals in HCA Healthcare, Tenet, Providence and UPMC systems were fully compliant with federal price transparency rules, according to a new analysis.

By Hailey Mensik • Feb. 6, 2023

CMS issues 2% MA rate hike for 2024

Trade association AHIP said it was “concerned with the potential adverse impact of the rate notice,” especially in light of other recent regulation seeking to claw back overpayments to MA payers.

By Shannon Muchmore • Feb. 2, 2023

Texas Medical Association files fourth suit challenging surprise billing ban

The latest lawsuit focuses on boosted fees that both parties must pay for arbitration to solve billing disputes between providers and payers.

By Hailey Mensik • Feb. 1, 2023

FTC orders GoodRx to stop sharing users’ health data with advertisers, issues $1.5M fine

Officials said they’re putting the market on watch with the enforcement against the company, which allegedly collected and shared user data without consent. GoodRx denied all wrongdoing, and said it agreed to the fine to avoid litigation.

By Rebecca Pifer Parduhn • Updated Feb. 1, 2023

CMS to crack down on Medicare Advantage audits, poised to claw back billions of dollars from insurers

Federal regulators have raised concerns about alleged payment abuses in the MA program for years, specifically for those tied to risk adjustments. 

By Samantha Liss • Jan. 31, 2023

Insurance lobby blasts Medicare Advantage audit rule

The America’s Health Insurance Plans lobby said the rule seeking to claw back billions of dollars from health insurers is unlawful and fatally flawed. 

By Samantha Liss • Jan. 31, 2023

COVID-19 public health emergency slated to end in May

The Biden administration warned that hospitals are at risk of revenue losses and care delays if the public health emergency ends abruptly.

By Samantha Liss • Jan. 31, 2023

Court rules for drugmakers over HHS in 340B fight over contract pharmacies

The decision is a win for drug manufacturers Sanofi, Novo Nordisk and AstraZeneca. The companies sued the HHS after regulators ordered them to stop restricting sales of 340B drugs to contract pharmacies.

By Rebecca Pifer Parduhn • Jan. 31, 2023

Biden admin moves to undo moral opt-out to ACA contraceptive mandate

The rule also would create an option allowing people enrolled in health coverage or plans provided by “objecting entities” to obtain contraceptive coverage.

By Ryan Golden • Updated Jan. 30, 2023

Minnesota attorney general asks Sanford-Fairview to delay merger

“It’s more important to do this right than to do it fast,” Minnesota’s Chief Deputy Attorney General John Keller said regarding the deal. 

By Samantha Liss • Jan. 30, 2023

Louisiana sends cease-and-desist order to Express Scripts over delayed insurance claims

State officials began investigating Express Scripts in April after receiving multiple complaints from an independent pharmacy association over the Cigna-owned PBM’s handling of claims.

By Rebecca Pifer Parduhn • Updated Jan. 31, 2023

Record-breaking 16.3M people signed up for ACA coverage

The 2023 enrollment numbers reflect a broader policy push from the Biden administration to increase insurance coverage, especially during the pandemic.

By Sydney Halleman • Jan. 25, 2023

More states propose nurse staffing, ratio laws

Lawmakers in three states are considering legislation around healthcare worker staffing and nurse-to-patient ratios after the pandemic caused the industry to suffer major workforce challenges.

By Hailey Mensik • Jan. 24, 2023

US to jack up fees for big mergers

Filing fees are expected to soar this year and companies, including those in healthcare, will need to prepare for increased regulatory scrutiny of M&A deals.

By Alexei Alexis • Jan. 23, 2023

Nonprofit hospitals may evade noncompete ban enforcement, experts say

Ambiguity remains over whether the ban would apply to nonprofit systems, which make up about half of all U.S hospitals.

By Samantha Liss • Jan. 20, 2023

More than quarter of ground ambulance transports could result in surprise bill

Ground ambulances were left out of federal legislation banning surprise billing, but the sector may be ripe for similar regulation given the prevalence of out-of-network rides, according to research in Health Affairs.

By Samantha Liss • Jan. 19, 2023

Major government ACOs to cover 13.2M people this year

Accountable care organizations and value-based care advocates cheered the news, with the National Association of ACOs calling 2023 a “turning point” for growth.

By Rebecca Pifer Parduhn • Jan. 18, 2023

Uninsured rate fell for those historically lacking coverage

Researchers in an HHS report said policies like Medicaid continuous coverage and premium tax credits were key to the reduction.

By Shannon Muchmore • Jan. 17, 2023

California files suit against PBMs over insulin prices

The state filed suit Thursday against pharmacy benefit managers CVS Caremark, Express Scripts and OptumRx, alleging they worked with drugmakers to drive up the price of insulin.

By Hailey Mensik • Jan. 13, 2023

Extended subsidies boost ACA marketplace enrollment

Nearly 16 million people have signed up for health coverage through the Affordable Care Act marketplace since open enrollment began Nov. 1

By Hailey Mensik • Jan. 11, 2023

Hospitals disappointed with court ruling placing HHS in charge of 340B repayment

The court’s ruling on Tuesday is the latest update in a yearslong legal dispute between safety net hospitals and the government over payment rates.

By Rebecca Pifer Parduhn • Jan. 11, 2023

COVID-19 vaccine prices are going up. It shouldn’t be our focus.

Vaccinating as many people as possible to reduce the spread of respiratory illness that can be especially life-threatening for the youngest and oldest Americans is key, argues vaccine law professor Richard Hughes IV.

By Richard Hughes IV • Jan. 10, 2023

Sen. Bernie Sanders to target high healthcare costs as leader of influential committee

The longtime Congressman and “Medicare for All” proponent will soon assume leadership of the Senate HELP committee, giving him sway in one of the nation’s most broadly influential health policy forums.

By Sydney Halleman • Jan. 9, 2023

FDA approves Alzheimer’s drug from Eisai, Biogen in closely watched decision

The agency’s approval comes months after a large clinical trial showed the drug, called Leqembi, could slow the disease’s progression. Yet experts have raised concerns about its safety.

By Jacob Bell • Jan. 6, 2023

California revises Medicaid contract awards, adding 2 insurers

Five insurers will now receive lucrative contracts to provide managed care services, starting in 2024, in the country’s largest Medicaid market.

By Susan Kelly • Jan. 4, 2023