July 07, 2022
MAYA GOLDMAN
The Medicare Shared Savings Program could see big changes soon if the Centers for Medicare and Medicaid Services enacts a set of policies unveiled Thursday.
Category: News
Government watchdogs attack Medicare Advantage for denying care and overcharging
June 29, 2022
Fred Schulte, Kaiser Health News
Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the government billions of dollars every year, government watchdogs told a House panel Tuesday.
DaVita loses employer health plan case at Supreme Court
June 21, 2022
MAYA GOLDMAN
An employer health plan didn’t violate federal law by limiting outpatient dialysis benefits for policyholders, the Supreme Court ruled Tuesday.
Hospitals win 340B lawsuit at Supreme Court
June 15, 2022
MAYA GOLDMAN
The Health and Human Services Department does not have the discretion to change 340B reimbursement rates without gathering data on what hospitals pay for outpatient drugs, the Supreme Court ruled Wednesday.
FTC takes aim at PBM business practices in new inquiry
June 07, 2022
MAYA GOLDMAN
The Federal Trade Commission will intensify its scrutiny of pharmacy benefit manager business practices, the agency announced Tuesday.
2 million affected in Shields Health Care Group cyberattack
June 07, 2022
MAX ABRAMS
Two million people who sought care at more than 50 Shields Health Care Group partners across the New England region may have had their personal data exposed after the company’s network server was breached in March.
AHA wants False Claims Act enforcement of Medicare Advantage care denials
May 20, 2022
MAYA GOLDMAN
The American Hospital Association on Thursday urged the Justice Department to conduct more False Claims Act investigations of Medicare Advantage insurers for denying patients access to services and payments to providers.
Rates of unnecessary procedures persisted through pandemic, study shows
May 17, 2022
MARI DEVEREAUX
Despite the risks posed by COVID-19, hospitals continued to perform eight common, low-value procedures during the first year of the pandemic at a rate similar to 2019, according to a Lown Institute analysis published Tuesday.
Supreme Court abortion draft creates tangle of issues for big hospital systems
May 03, 2022
MAYA GOLDMAN
ALEX KACIK
Striking down Roe v. Wade would disrupt healthcare providers’ operations and increase their legal liability, lawyers and policy experts said.
MA plans deny care traditional Medicare would cover, investigation finds
April 28, 2022
Mari Devereaux & Maya Goldman
Medicare Advantage insurers could soon see more oversight of prior authorization practices.