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Feds sue UPMC, heart surgeon for billing multiple surgeries at same time
The False Claims Act litigation also accuses the health system of ignoring or minimizing complaints by employees and staff.
By Ron Shinkman • Sept. 7, 2021 -
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Sponsored by ZelisThe low-down on the latest NSA Member ID and Advanced EOB Requirements
What you need to know about new NSA requirements for Member ID cards & AEOBs to reach compliance.
Sept. 7, 2021 -
Explore the Trendline➔
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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 -
Adeline Kon/Healthcare Dive
AHA presents Congress with laundry list of requests for budget reconciliation bill
The hospital lobby asked that some of the funding be used to address the ongoing labor shortage, shore up mental health services and address ongoing coverage gaps.
By Ron Shinkman • Sept. 3, 2021 -
National Institute of Allergy and Infectious Diseases. (2020). "Novel Coronavirus SARS-CoV-2" [Micrograph]. Retrieved from Flickr.
Pfizer, Merck launch large new trials of oral COVID-19 drugs
Both companies are racing to prove their oral antivirals are effective as treatments for COVID-19. Key clinical results could come later this year.
By Kristin Jensen • Sept. 2, 2021 -
Medicare insolvency still expected by 2026, unchanged by COVID-19, trustees say
The forecast is a bit of a bright spot for the otherwise grim financial prospects of the program, as experts worried COVID-19 would result in the fund that finances Medicare Part A running out of money faster than previously expected.
By Rebecca Pifer Parduhn • Sept. 1, 2021 -
Megan Quinn/Healthcare Dive
Hospital lobby urges Congress to extend Medicare cut relief
The cuts, if they go through, will result in an estimated loss of $36 billion in funding in 2022 alone, the Federation of American Hospitals said.
By Rebecca Pifer Parduhn • Sept. 1, 2021 -
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Hospitals lose legal challenge over changes to DSH payments
A federal judge sided with HHS, pointing to a portion of the Medicare law that prohibits any administrative and judicial review of how the department arrived at its calculations.
By Samantha Liss • Sept. 1, 2021 -
Sutter to pay $90M in largest False Claims Act settlement against a health system for alleged MA fraud
The record payment comes on the heels of another massive settlement for the nonprofit, adding to the hit on its already stressed bottom line.
By Rebecca Pifer Parduhn • Aug. 31, 2021 -
Courtesy of Eli Lilly
FDA restarts distribution of Lilly's COVID-19 drug in 22 states
Use of the treatment had been halted due to weakened efficacy versus an early coronavirus variant. Now, with delta widely prevalent and demand for antibody treatments surging, Lilly's therapy will be available again.
By Shoshana Dubnow • Aug. 31, 2021 -
Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.
New Jersey hospitals appeal FTC merger challenge
Hackensack Meridian Health, the largest health system in New Jersey, wants to to acquire a close competitor. The Federal Trade Commission won an injunction to stop the deal, which is now headed to an appeals court.
By Samantha Liss • Aug. 30, 2021 -
Philips sleep apnea, ventilator recall triggers US lawmaker scrutiny, legal woes
Patients seeking class-action status and Sen. Richard Blumenthal are questioning the medtech's timing of the recall and outreach to patients. Philips has not quantified the impact of the suits but said it could be material.
By Nick Paul Taylor • Updated Aug. 28, 2021 -
North Carolina amends certificate of need in bill headed to governor's desk
The laws came under scrutiny as the COVID-19 pandemic gripped the nation last year and overwhelmed hospital resources, raising questions about the value of the restrictions.
By Samantha Liss • Aug. 26, 2021 -
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J&J, without details, makes case for a coronavirus booster shot
A second shot given six months after the first appears to provide a bigger immune response, the company said, a finding J&J aims to take to regulators in the U.S. and elsewhere.
By Ben Fidler • Aug. 25, 2021 -
Medicaid, ACA policies for COVID-19 kept rate of uninsured steady, researchers find
The uninsured rate remained at 11% from March 2019 to April 2021, thanks to a freeze in Medicaid disenrollment and increased ACA subsidies, according to a report from the Urban Institute.
By Hailey Mensik • Aug. 24, 2021 -
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FDA grants full approval to Pfizer, BioNTech's coronavirus vaccine
The long-awaited decision could strengthen the case for vaccine mandates as public health officials seek to boost rates of immunization amid a wave of COVID-19 cases.
By Jonathan Gardner • Updated Aug. 23, 2021 -
Win McNamee via Getty Images
Biden said to rule out Woodcock as permanent FDA chief
A news report indicated the agency's longtime drug reviewer is no longer in consideration for the role, leaving the FDA's top job in flux as key decisions near on coronavirus booster shots and vaccinations for children.
By Jonathan Gardner • Aug. 20, 2021 -
AHA moves to shift cost blame to health plans in letter to antitrust regulators
The letter included an updated AHA-funded study on the benefits of hospital mergers, which was previously criticized by outside experts for cherry-picked data, among other methodological weaknesses.
By Rebecca Pifer Parduhn • Aug. 19, 2021 -
Opinion
The federal price transparency rules have critical gaps that must be addressed to achieve their objectives
Castlight Health CEO Maeve O'Meara argues that if regulations aren't implemented in a meaningful way for consumers, the efforts will likely fail to inform healthcare decision making and achieve the desired cost savings.
By Maeve O'Meara • Aug. 18, 2021 -
Payments to MA plans raised overall Medicare spend by $7B in 2019, analysis finds
The Kaiser Family Foundation chalked the higher spending up to how MA is paid, including how benchmarks for plan payments are set and the risk adjustment process.
By Rebecca Pifer Parduhn • Aug. 18, 2021 -
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US to offer coronavirus boosters to all Americans in aggressive plan to counter delta's spread
The Biden administration's call comes ahead of FDA authorization for additional doses in people who aren't immunocompromised, although agency head Janet Woodcock joined other officials in supporting the plan.
By Ned Pagliarulo • Updated Aug. 18, 2021 -
Image courtesy of FDA
Medtechs need to up their cybersecurity threat modeling game, FDA says
The agency "will be looking for much more detailed and comprehensive" cyber threat models as part of premarket review, said Suzanne Schwartz, director of CDRH's Office of Strategic Partnerships and Technology Innovation.
By Greg Slabodkin • Aug. 18, 2021 -
Medicaid redeterminations
CMS extends deadlines for Medicaid redeterminations after COVID-19 public health emergency ends
Due to significantly increased workloads, state health officials will now have 12 months instead of six after the PHE ends to complete pending verifications, redeterminations and renewals.
By Hailey Mensik • Aug. 17, 2021 -
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FDA authorizes third coronavirus vaccine dose for immunocompromised people
A CDC advisory panel is expected to vote on Friday to recommend the additional dose, after which certain people with weakened immune systems can receive a third shot of Pfizer's or Moderna's vaccine.
By Shoshana Dubnow • Aug. 13, 2021 -
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UnitedHealth settles for $15.6M after Labor Department finds mental health cuts, denials
"You should expect to see more investigation," of those not abiding by the federal mental health parity law, a top DOL official said. "I predict this will be a very active issue for us for years to come."
By Shannon Muchmore • Aug. 12, 2021 -
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Biden embraces Medicare drug price negotiation as Democrats seek to widen health coverage
But the proposal, which features several familiar and long-debated policy ideas, could face an uphill battle in Congress as the drug industry lines up against it.
By Jonathan Gardner • Updated Aug. 12, 2021
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