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Medicare Advantage plan audits illustrate overcharging
An analysis found overpayments for unsupported medical diagnoses exceeded $10,000 per patient for more than 150 patients across 37 audits.
By Heather Caspi • Aug. 30, 2016 -
CA lawmakers send legislation against surprise medical bills to Gov. Brown
Hospitals in the state may be required to notify patients if they are receiving observation care beginning Jan. 1, 2017.
By Ana Mulero • Aug. 30, 2016 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/provider relationships
As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
Here's how many ACA enrollees KFF estimates will face insurer monopolies for 2017
Fewer marketplace consumers will be able to "shop around."
By Heather Caspi • Aug. 30, 2016 -
CMS proposes standards to strengthen 2018 ACA market
The proposed rule includes some changes to improve risk adjustment policies.
By Jeff Byers • Aug. 29, 2016 -
UPMC insures a fair amount of people now
The provider ended its fiscal year by netting $12.8 billion in operating revenues.
By Jeff Byers • Aug. 29, 2016 -
Uwe Reinhardt: Adverse risk selection crippling Obamacare
National health spending is projected to grow just 4.8% this year, according to CMS.
By Meg Bryant • Aug. 26, 2016 -
Medicare ACOs saved $466M in 2015. Only a third earned shared savings
On the quality front, the organizations improved on 84% of the quality measures reported from 2014 to 2015.
By Jeff Byers • Aug. 26, 2016 -
Obesity risks scale to 13 cancers, research finds
The research review, in the New England Journal of Medicine, also found limited evidence tying obesity to three other cancers.
By Meg Bryant • Aug. 26, 2016 -
Kentucky seeks waiver to overhaul expanded Medicaid program
The governor is looking to reel in costs before the state is required to start paying its share.
By Heather Caspi • Aug. 25, 2016 -
Alex Wong via Getty Images
HHS: Medicaid expansion helped lower ACA premiums by 7%
The analysis shows premiums in non-expansion states reflect a different risk pool.
By Jeff Byers • Aug. 25, 2016 -
Deep Dive
How does geography impact C-section rates
A Blue Cross Blue Shield Association analysis found C-section rates varied from 25% to 50% from July 2010 through June 2015.
By Ana Mulero • Aug. 25, 2016 -
Nosedive in insurer ACA participation leaves many with just one choice
Healthcare.gov is expected to be less competitive in 2017 than when it launched in 2014.
By Heather Caspi • Aug. 25, 2016 -
'Overwhelming majority' of ACA consumers to have affordable choices, HHS says
Will consumer choice pan out as a tactic for finding affordable plans?
By Heather Caspi • Aug. 25, 2016 -
Deep Dive
ACA woes grow as insurers back out. Is a Medicaid managed care model the answer?
The nation's largest private payers are losing faith and millions of dollars in ACA exchanges. Payers offering low cost plans with narrow networks may end up driving their success.
By Luke Gale • Aug. 24, 2016 -
Humana's Broussard predicts blockchain technology to transform healthcare
While too soon to tell, Humana's top dog is touting the technology's potential transformation to the industry.
By Heather Caspi • Aug. 24, 2016 -
Clinton plans to help small businesses provide health coverage
The Democratic presidential nominee will propose an expansion of a currently under-utilized healthcare tax credit.
By Heather Caspi • Aug. 24, 2016 -
Not so different after all: Losses lead Oscar to market pull-outs
The insurer is increasingly adopting strategies akin to those of its rivals.
By Heather Caspi • Aug. 24, 2016 -
CBO: Aging population, drugs driving federal healthcare spending
This year will be the first time the annual budget shortfall will increase since 2009.
By Ana Mulero • Aug. 24, 2016 -
Companies managing Medicaid in Iowa losing millions
Managed care is supposed to save money, but early losses suggest payers could raise rates when they renegotiate contracts.
By Luke Gale • Aug. 24, 2016 -
New York's HealthNow settles over $1.6M in denied behavioral health claims
Mental-health parity continues to be an issue in New York and around the U.S.
By Heather Caspi • Aug. 23, 2016 -
USDA
Blue Cross and Blue Shield of NC duking it out with state regulators on IT complaints
The N.C. Department of Insurance said the insurer has racked up 3,444 complaints so far this year.
By Heather Caspi • Aug. 23, 2016 -
Elizabeth Regan/Healthcare Dive
Here are the hospitals that received $1.5B from CMS to clear Medicare appeals backlog
The payments went to over a third of U.S. hospitals.
By Jeff Byers • Aug. 23, 2016 -
OCR puts organizations on notice for smaller data breaches
Expect to see more HIPAA settlements as HHS steps up investigations of smaller breaches.
By Meg Bryant • Aug. 23, 2016 -
Aetna/Humana deny DOJ's antitrust allegations
The insurers argued the DOJ has failed to understand that Medicare Advantage plans are "privately administered managed care products."
By Ana Mulero • Aug. 22, 2016 -
Reinsurance key for risk adjustment, stabilizing marketplace, research finds
Only 1% of patients in the 2013 sample group were very costly but they accounted for 28% of total annual healthcare costs.
By Ana Mulero • Aug. 22, 2016
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