Government: Page 92
-
HHS watchdog accuses MA plans of inflating payments by nearly $7B annually
The apparent overpayments are tied to payers tacking on new diagnosis codes as part of a review of existing medical charts, a practice CMS is encouraged to watch more closely.
By Ron Shinkman • Dec. 13, 2019 -
Hospital group cheers CMS move to pay back outpatient payment cuts
Despite the win for hospitals, the showdown is likely to ramp up again as the federal regulator said it will keep the controversial site-neutral policy for 2020.
By Samantha Liss • Dec. 13, 2019 -
Amid legal roadblocks, CMS clears South Carolina Medicaid work mandates
The administration has approved work requirements in ten states so far, though three (New Hampshire, Kentucky and Arkansas) have seen their programs struck down by a federal judge.
By Rebecca Pifer Parduhn • Dec. 12, 2019 -
Few Medicare Advantage plans add new benefits for serious illness
Starting this year, CMS gave the plans flexibility to offer more benefits for nonmedical services like home-based palliative care, adult daycare services, bathroom safety devices and modifications.
By Linda Wilson • Dec. 11, 2019 -
Surprise billing ban draft: Middle ground leaves few pleased
The bill backed by a bipartisan group of Senate and House leadership would require insurers pay at least the median in-network negotiated rate for the area market for out-of-network services and has an arbitration backstop.
By Shannon Muchmore • Dec. 10, 2019 -
Supreme Court to hear $12B ACA risk corridors case this week
The justices will consider the case Tuesday. Observers say the money will not be the ultimate thrust of the court's decision — it's whether the business sector will have trust in the federal government in current and future partnerships.
By Ron Shinkman • Dec. 9, 2019 -
Competing House surprise billing plan muddies path of White House-backed legislation
The House Ways and Means Committee unveiled its own surprise billing legislation Wednesday that relies on arbitration.
By Shannon Muchmore • Updated Dec. 12, 2019 -
Biotech's Alzheimer's pitch polarizes scientists
Two large clinical trials testing Biogen's drug aducanumab in patients with less advanced disease looked negative after early analyses, leading the company to stop them before they finished.
By Jacob Bell • Dec. 9, 2019 -
Yujin Kim/Healthcare Dive
Dive Awards
The Healthcare Dive Awards for 2019
From the Affordable Care Act lawsuit to CVS Health CEO Larry Merlo, these are the companies, executives and movements that shaped U.S. healthcare this year.
Dec. 9, 2019 -
Roche MRSA test wins FDA OK
The agency said the novel diagnostic technology can deliver results in as little as five hours, compared to the one- to two-day wait time with conventional methods.
By Nick Paul Taylor • Dec. 6, 2019 -
US healthcare spending growth rebounded last year, influenced by insurance tax
Hospital and physician and clinical services spending fell, but prices were up. CMS Administrator Seema Verma blamed provider consolidation and the "creation of monopolies."
By Shannon Muchmore • Dec. 5, 2019 -
More state laws back telehealth, but many stop short of mandates
While regulations have inhibited growth in the past, many states are warming up to the adoption of virtual services. That's a "sea change compared to a decade ago," Foley & Lardner lawyers said.
By Linda Wilson • Dec. 5, 2019 -
Medicare Advantage members rarely review or switch plans
A Kaiser Family Foundation analysis found that more than one in three Medicare beneficiaries reported difficulty comparing plan options and nearly half of those on Medicare said they rarely or never review their choices.
By Shannon Muchmore • Dec. 4, 2019 -
Disparities between care in rural, urban areas getting worse
"The game is rigged," Janice Probst, a professor at the University of South Carolina's Arnold School of Public Health, said. "If we don't change the game, we never win."
By Rebecca Pifer Parduhn • Dec. 4, 2019 -
Deep Dive
Will sky-high drug prices spur the US to use an obscure power over patents?
New cell therapies as well as gene-based treatments like Zolgensma benefited from NIH funding of early-stage research. Advocates say the time is now for the government to invoke its "march-in" rights.
By Jonathan Gardner • Dec. 4, 2019 -
Senators push CMS, commercial payers on bias in algorithms
The letters sent to UnitedHealth, Blue Cross Blue Shield, Cigna, Humana and Aetna flagged a study that found racial bias in a widely used algorithm for assessing healthcare needs.
By Susan Kelly • Dec. 4, 2019 -
Hospitals sue HHS, warning price transparency rule would chill competition, crash computers
An agency spokeswoman shot back that hospitals "should be ashamed that they aren't willing to provide American patients the cost of a service before they purchase it."
By Samantha Liss • Dec. 4, 2019 -
'Refusal to properly report' data breach spurs $2.175M fine for Sentara Hospitals
"When healthcare providers blatantly fail to report breaches as required by law, they should expect vigorous enforcement action," HHS Office of Civil Rights chief Roger Severino said.
By Ron Shinkman • Dec. 2, 2019 -
Fitch says 2020 healthcare environment bumpy but negotiable
The legal fate of the Affordable Care Act is one of several uncertainties, according to the report. Ongoing opioid litigation is another.
By Ron Shinkman • Nov. 27, 2019 -
US life expectancy down in recent years after increasing for decades
Researchers noted the decline comes despite the U.S. spending far more than other high-income countries on healthcare. Deficiencies in the system "could potentially explain increased mortality from some conditions," they wrote.
By Shannon Muchmore • Nov. 26, 2019 -
Mandatory CMS radiation oncology model goes on backburner
Originally, the agency was eyeing an implementation date as early as Jan. 1, but the new regulatory agenda lists July 2022 as a target date for the bundled payment model.
By David Lim • Nov. 26, 2019 -
Retrieved from U.S. Environmental Protection Agency.
AdvaMed lobbied EPA chief Wheeler on cancer report amid delay in ethylene oxide regs
Group purchasing organizations working with hospitals are already seeing the impacts of the closure of ethylene oxide sterilization facilities, said David Gillan, senior vice president of sourcing operations at Vizient.
By David Lim • Nov. 25, 2019 -
Medical devices bigger culprit in antibiotic-resistant infections than surgical procedures, CDC analysis shows
Antibiotic resistance was higher in hospital-associated infections linked to use of devices like central lines, ventilators and urinary catheters, according to data collected from more than 5,600 sites between 2015 and 2017.
By Susan Kelly • Nov. 25, 2019 -
Michigan focus of latest lawsuit over Medicaid work rules
It's the latest court protest of Medicaid work requirements in the nine states that obtained waivers. Most of the challenges have prevailed.
By Ron Shinkman • Nov. 25, 2019 -
Uncompensated care up significantly at US hospitals, led by Southeast
Smaller hospitals and those in states that did not expand Medicaid under the Affordable Care Act were most hit, according to a new survey.
By Ron Shinkman • Nov. 22, 2019
Previous
