Motive, perpetrator remain elusive in shooting death of UnitedHealthcare CEO Brian Thompson
Media reports and law enforcement sources described Wednesday morning’s fatal shooting of UnitedHealthcare CEO Brian Thompson as a targeted attack against a high-profile executive, but as of early evening, police could not say why it happened. Thompson, 50, a married father of two teenage children, was walking toward the New York Hilton Hotel in Midtown…
2 proposed rules seek to stem insurers’ use of prior authorization, medical management
In its waning days, the Biden administration hopes to lay additional groundwork for curbing health plan policies regarding prior authorization in Medicare Advantage (MA), along with group health plan tactics that may interfere with access to certain preventive items and services. MA prior authorization criteria A proposed rule implementing 2026 policy and technical changes for…
A nearly $3 billion settlement with Blue Cross Blue Shield leaves providers with a big choice
Providers that contract with Blue Cross Blue Shield should assess whether they want to participate in a landmark class-action settlement over litigation stemming from complaints about the insurer’s business practices. In October, a resolution reached between provider plaintiffs and Blue Cross Blue Shield Association (BCBSA), along with 33 of its member companies, resulted in a…
Medicare, Medicaid are set to cover GLP-1 drugs under a Biden administration proposal
In a major development for Medicare and Medicaid, the Biden administration has issued a proposal for the program to cover a class of weight-loss drugs that have become increasingly prevalent in society. A proposed rule implementing Medicare Advantage and Medicare Part D technical and policy changes for 2026 includes a provision to reinterpret statutory language…
Biden’s director of Medicaid expresses concern for the program’s future amid talk of block grants
In what amounted to a valedictory for CMS leadership as it has been constituted during the Biden administration, the head of Medicaid expressed concern about the potential for big changes to the program. Daniel Tsai, director of the Center for Medicaid and CHIP services, said the possible transformation to a block-grant program under the incoming…
HHS watchdog flags improper payments to hospitals for services provided to hospice patients
Hospitals may face closer scrutiny over a segment of Medicare outpatient billing after the HHS Office of Inspector General (OIG) found improper payments. In a report posted Nov. 18, OIG found that improper payments were prevalent for outpatient services provided to hospice enrollees during a five-year period ending in 2021. Examining a sample size of…
2 drug manufacturers go to court to turn 340B into a rebate program
Two leading drug manufacturers have pressed forward with efforts to reformat the 340B Drug Pricing Program, filing lawsuits against the federal government over the question of whether savings can be offered as cash rebates rather than up-front discounts. Johnson & Johnson took HHS and the Health Resources and Services Administration (HRSA) to federal court in…
An eventful period for healthcare policy looms as Trump and GOP members of Congress prepare to govern
President-elect Donald Trump and congressional Republicans are expected to implement changes to healthcare policy, including site-neutral payment, price transparency, and modifications to Medicare and Medicaid, while the nomination of Robert F. Kennedy Jr. as HHS Secretary and Mehmet Oz as CMS Administrator could have implications for the healthcare system.
What the site-of-care shift for joint replacement means for hospitals
Hospital patient volumes mostly have been on an upswing since the worst of the COVID-19 pandemic, but certain trends represent cautionary tales for long-term finances. For example, the latest report (registration required) from Strata Decision Technology shows a year-over-year decline in August of more than 21% for inpatient primary knee replacement procedures. A shift to…
Medicare’s 2025 payment updates: Why hospitals and physicians think the methodologies are flawed
Neither hospitals nor physicians found much reason for encouragement in final 2025 Medicare payment rules released Nov. 1. The rules, which were made available as pre-publication drafts, finalized a 2.9% increase for hospitals under the payment system for Medicare outpatient services and ambulatory surgical centers (ASCs). Meanwhile, physicians were dealt a 2.83% cut that they…