Category: News

April 29, 2024

NONA TEPPER  

A rural health system sued technology company MultiPlan and eight of the country’s largest insurance companies over alleged schemes to strongarm providers into accepting low out-of-network rates. 

At issue in the proposed class-action suit are MultiPlan’s repricing tools, which allegedly rely on insurers’ data to deflate their out-of-network reimbursement payments.

MultiPlan acts as an intermediary between insurers and providers to help negotiate pay when a contract does not exist and protect patients from being “balance billed,” or charged the difference between the hospital rate and insurer’s allowed amount.

April 24, 2024

Leah Nylen, Bloomberg

Business groups led by the US Chamber of Commerce sued the Federal Trade Commission Wednesday seeking to block a rule finalized this week that would outlaw non-compete provisions that prohibit workers from switching jobs within an industry.

In a complaint filed in Texas federal court, the nation’s largest business lobby argued that the antitrust and consumer protection agency lacks the authority to issue rules that define unfair methods of competition. The FTC Act, which established the agency, allows it to bring cases challenging particular practices, the group said, but not to write rules. The Chamber was joined by Business Roundtable and several Texas business groups in challenging the rule.

April 17, 2024

Lauren Coleman-Lochner, Bloomberg

Private equity-owned businesses accounted for a high number of bankruptcies in the healthcare sector last year, and another wave of distress looms, according to a new report from an advocacy group that monitors the sector.

PE-backed firms accounted for at least 17, or about a fifth, of the 80 bankruptcies of healthcare companies last year, the Private Equity Stakeholder Project said in a report due to be released Wednesday. It called 2023 a “record year” for large health-care bankruptcies. Also, venture-capital backed companies made up another 12, or 15%, of the filings, it said in a study that looked at companies with liabilities of more than $10 million. 

April 01, 2024

LAUREN BERRYMAN   
NONA TEPPER 

Medicare Advantage insurers will get lower payments next year, the Centers for Medicare and Medicaid Services confirmed in a final rule published Monday.

The Medicare Advantage benchmark rate will decline 0.16% in 2025 under the regulation, which is the same amount the agency proposed in January. This marks the second consecutive year CMS reduced the benchmark rate.

April 04, 2024

KARA HARTNETT  

Healthcare consolidation is expected to remain strong in the coming months, given likely cuts in interest rates, health systems’ ongoing pursuit of financial stability and expansion opportunities, and the growing influence of private equity in care delivery.

Private equity firms are increasingly acquiring physician practices and healthcare staffing firms, while hospitals are exploring mergers to reduce costs through economies of scale. Additionally, the industry is seeing growing interest in forming joint ventures and affiliations to bolster financial resilience and diversify services.

March 25, 2024

TIM BRODERICK 
LAUREN BERRYMAN 

The healthcare industry is starting to play catch-up following a cyberattack on UnitedHealth Group’s Change Healthcare subsidiary nearly five weeks ago that forced the company to disconnect its vital everyday systems.

Change Healthcare processes about 50% of medical claims and manages prior authorization requests and reimbursement processes. The unprecedented network outage has forced hospitals, nursing homes, pharmacies and other providers to scramble as they try to mitigate operational and financial challenges.

March 13, 2024

LAUREN BERRYMAN   

The federal government has launched an investigation into UnitedHealth Group and its Change Healthcare subsidiary regarding the unprecedented cyberattack inflicted on the technology company that has wreaked havoc throughout the healthcare system.

Melanie Fontes Rainer, director of the Health and Human Services Department’s Office for Civil Rights, announced the probe Wednesday in a letter addressed to colleagues. 

The agency is looking into whether protected health data was compromised and if UnitedHealth has complied with breach notification requirements and federal privacy and security rules.

March 05, 2024

LAUREN BERRYMAN   

The Centers for Medicare and Medicaid Services has rolled out efforts to help providers navigate the Change Healthcare outage disrupting healthcare operations nationwide, the Health and Human Services Department announced Tuesday.

CMS ordered its claims administrators to assist pharmacies, hospitals and others that need to use alternate means to process transactions while Change Healthcare, part of UnitedHealth Group’s Optum subsidiary, works to get its systems back online following a Feb. 21 cyberattack. The agency also offered assistance to address the financial squeeze some providers are enduring.

February 26, 2024 

LAUREN BERRYMAN   

Pharmacies and providers still struggling with disarray six days after UnitedHealth Group division Change Healthcare suffered a cyberattack.

The incident, which the company blames on an unnamed foreign government, continues to disrupt operations for Change Healthcare customers and will persist until at least Tuesday, Change Healthcare disclosed Monday. Clients have faced significant obstacles completing basic tasks such as handling prescriptions and claims. 

January 30, 2024

MICHAEL MCAULIFF   

If anyone were to ask members of Congress if doctors should be contending with Medicare pay cuts after a pandemic and a period of extraordinary inflation, and amid a chronic physician shortage, nearly all would say no.

Yet, that is what happened on Jan. 1, and even powerful lawmakers who would like to ease or reverse that cut can’t promise it will happen, even after recent actions to forestall hospital cuts and to extend expiring healthcare programs such as federally qualified health centers.