Government: Page 5

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    Covert watchdog testing finds ACA vulnerable to subsidy fraud

    The Government Accountability Office successfully enrolled 18 out of 20 fake applicants in subsidized ACA plans. Republicans jumped on the report as ammunition in the debate over expanded subsidies.

    By • Dec. 4, 2025
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    House passes bill extending hospital-at-home waivers for five years

    The bill would waive certain requirements to enable hospitals to provide acute inpatient care in patients’ homes through 2030. It now heads to the Senate.

    By • Dec. 3, 2025
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    CVS agrees to pay $38M to settle insulin fraud claims

    For a decade, CVS knew it was skirting rules meant to limit overprescribing but did nothing to stop, according to the Department of Justice.

    By • Dec. 3, 2025
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    Trump administration repeals Biden-era nursing home staffing mandate

    HHS repealed the rule on Tuesday, which would have required nursing homes to increase staffing, saying the regulations would have disproportionately harmed rural communities.

    By Susanna Vogel • Dec. 3, 2025
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    Richard Pazdur, FDA drug czar, to retire from agency

    Weeks after being named head of CDER, Pazdur has submitted paperwork to step down at the end of the month, exacerbating what’s already been a turbulent year at the FDA.

    By Ben Fidler • Dec. 2, 2025
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    Hospitals sue to block HHS 340B rebate pilot

    The American Hospital Association, a Maine hospital group and four nonprofit systems are seeking a temporary restraining order against HHS’ controversial test of a new discount structure in the decades-old program.

    By • Dec. 2, 2025
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    Humana appeals Medicare Advantage star ratings loss to 5th Circuit

    The insurer continues to try to prove that regulators acted arbitrarily in downgrading its quality scores for 2025, despite numerous setbacks in the courts to date.

    By • Dec. 1, 2025
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    CMS proposes overhauling Medicare Advantage star ratings

    The agency suggested cutting a dozen quality measures where health plan performance is high and beneficiaries can’t easily distinguish between offerings.

    By • Nov. 26, 2025
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    OIG report finds Medicare overpaying for CGMs and supplies

    The CMS could use its competitive bidding program to address price concerns after payments for the continuous glucose monitors swelled over five years, the government watchdog said.

    By Elise Reuter • Nov. 26, 2025
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    Lawmakers propose Medicare reimbursement pathway for AI devices

    The legislation is intended to ensure AI-enabled devices receive an accurate CMS payment code.

    By Nick Paul Taylor • Nov. 26, 2025
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    CMS sets 2027 Medicare prices for Wegovy, Trelegy and 13 other drugs

    The second round of negotiations cuts spending an aggregate 44% over 2024 list prices as the federal government extends restraints over more medicines.

    By Jonathan Gardner • Nov. 26, 2025
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    HHS brings back workers fired during shutdown

    HHS reinstated all 954 workers let go last month, but firing and rehiring employees is becoming a troubling trend at the agency.

    By Susanna Vogel • Nov. 26, 2025
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    Trump administration appeals decision vacating Medicare Advantage audit rule

    A federal judge struck down the rule that would have clawed back billions of dollars in overpayments in September. Now, the HHS wants to take the case to the Fifth Circuit Court of Appeals.

    By • Nov. 25, 2025
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    CMS finalizes 2.6% outpatient pay bump, site-neutral policies

    Hospitals lambasted the final rule as inadequate, arguing the sector is facing significant financial pressures.

    By • Nov. 24, 2025
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    Oracle Health designated QHIN under TEFCA data sharing framework

    Eleven data exchanges have now received Qualified Health Information Network status, more than double the number that were recognized when the federal government’s framework first went live in late 2023.

    By • Nov. 21, 2025
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    Crapo, Wyden to reintroduce bipartisan PBM package

    Republicans and Democrats couldn’t be further apart on how to address the looming ACA affordability cliff. But there seems to be a path forward on curbing pharmacy benefit managers.

    By • Nov. 20, 2025
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    Urban safety-net hospitals vulnerable to Medicaid cuts: analysis

    Though the impact on rural facilities has received more focus from lawmakers, the majority of hospitals that are most susceptible to the funding cuts operate in urban communities, according to the report.

    By • Nov. 19, 2025
  • The U.S. Capitol stands in the distance as morning traffic moves along North Capitol Street Northwest on October 01, 2025 in Washington, DC. The government shut down early Wednesday after Congress failed to reach a funding deal.
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    Republican antipathy during key Senate hearing darkens outlook for ACA subsidy extension

    More generous subsidies for Affordable Care Act plans have helped millions of Americans afford insurance. Chances are becoming slimmer that the assistance will survive the year.

    By • Nov. 19, 2025
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    States project flat Medicaid enrollment, increased spending as cuts loom: KFF

    Total spending in the safety-net insurance program is expected to grow 7.9% in fiscal year 2026, according to the survey. Meanwhile, states are facing significant federal cuts in the wake of the One Big Beautiful Bill Act.

    By • Nov. 18, 2025
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    CMS issues guidance on Medicaid provider tax overhaul

    The agency has started to lay out how it’ll implement restrictions on the arrangements, which are used by states to finance their share of Medicaid funding, enacted in the One Big Beautiful Bill Act.

    By • Nov. 17, 2025
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    Medicare premiums set to rise 10% next year, CMS says

    The Part B premium hike could have been worse, the Trump administration said. Still, it’s likely to pressure the pocketbooks of millions of seniors, and could drive more into Medicare Advantage plans.

    By • Nov. 17, 2025
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    Telehealth flexibilities reinstated as government shutdown ends

    The pandemic-era virtual care policies are back in place through Jan. 30. But short-term deals aren’t sustainable, telehealth advocates and providers say.

    By • Nov. 13, 2025
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    Historic government shutdown ends, leaving ACA subsidies in limbo

    The House passed a stopgap funding bill and President Donald Trump signed it after a weeks-long impasse, reopening the government without a clear path forward on preserving enhanced subsidies for ACA plans — Democrats’ chief demand.

    By • Nov. 13, 2025
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    Richard Pazdur, longtime FDA oncology leader, to head agency’s main drug office

    The appointment of Pazdur as CDER head comes shortly after the surprise ousting of George Tidmarsh and should quiet many of the “lingering uncertainties” surrounding the FDA, wrote one industry analyst.

    By Kristin Jensen • Nov. 12, 2025
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    FDA to remove safety warnings on hormonal menopause therapy

    The decision, issued without the input of an official advisory committee, revises long-held labeling on the drugs cautioning the risk of cancer and heart disease.

    By • Nov. 10, 2025