340B lawsuits against CVS allege $250M in underpaid hospital reimbursement
CVS Health’s pharmacy benefit manager (PBM) under-reimbursed three health systems by almost $250 million over five years in connection with the 340B Drug Pricing Program, according to new lawsuits. Filed in three separate federal courts, the complaints describe how CVS Health and its subsidiaries retained a large share of the savings generated through the 340B…
HFMA earns multiple editorial honors
HFMA’s editorial team has earned 12 national honors from two media organizations — the American Society of Business Publication editors (ASBPE) and the Software & Information Industry Association (SIIA) These awards are for work spanning 2025 healthcare industry coverage, special reports, newsletters, podcasts and design. “These awards reflect the depth of talent and teamwork behind…
Off-campus outpatient billing rules could extend to commercial claims
Hospitals preparing for new off-campus outpatient department (OPD) billing requirements in Medicare may soon face a parallel mandate for commercial claims. The House Education and Workforce Committee on May 21 unanimously passed the Transparency in Billing Act, which would prohibit commercial health plans from paying claims that do not include a unique identifier for the…
CMS’s Medicaid state-directed payment rule would expand limits beyond hospitals
CMS’s proposed rule on Medicaid state-directed payments (SDPs) would implement limits authorized by the One Big Beautiful Bill Act (OBBBA) while applying restrictions to a broader swath of Medicaid, including certain fee-for-service (FFS) supplemental payments. Essentially, the agency issued proposed regulations that would take some of the OBBBA’s Medicaid provisions a step further. Services previously…
Healthcare compliance risks rise as CMS expands fraud enforcement
With recent developments highlighting the Trump administration’s emphasis on healthcare fraud prevention, providers should ensure their compliance processes are working optimally. The administration has taken various steps in 2026, including this month. On May 13, CMS announced it was withholding $1.3 billion in Medicaid funding from California. During media availability at the White House that…
ACA marketplace final rule could add to payer-mix concerns for providers
In new regulations setting coverage parameters for Affordable Care Act (ACA) marketplace health plans, CMS is attempting to intertwine increased program integrity with greater flexibility for states and insurers. The balancing act is part of an effort to fortify the marketplaces in a year when enrollment already has fallen by more than 1 million after…
Healthcare price transparency is heading for a more consequential phase
Key developments loom for healthcare price transparency both legislatively and in the private sector, according to insights from a recent congressional hearing. Sen. Bill Cassidy (R-La.), who is a physician and an influential healthcare policymaker in Congress, conducted a field hearing May 5 with stakeholders in his home state to examine the issue of healthcare…
The Hospital of the Future Part I: Can healthcare leaders deliver a healthier future?
With support from: It’s a scene “The Jetsons” might have portrayed: A patient scheduled for surgery checks into the hospital by scanning a QR code with her smartphone, then is digitally led to her room. There, a smart TV welcomes her and orients her to the room. Soon, a robot arrives, delivering the gown she’ll change into…
GLP-1 coverage costs pressure employers and Medicare plans in 2026
Even as evidence accumulates about the efficacy of GLP-1 drugs, concerns surrounding insurance coverage of the products remain unresolved. Both employers and insurers are trying to navigate the dichotomy between clinical benefits and potentially burdensome costs. “Against the backdrop of anticipated double-digit healthcare cost increases, fueled to a large degree by GLP-1s and overall prescription…
Hospital workplace violence escalates financial and workforce pressures
Incidents of violence in U.S. workplaces are disproportionately common in healthcare settings, especially in hospital emergency departments (EDs), and new data helps quantify the toll. It’s long been known that healthcare and social service workers are significantly more likely than workers overall to suffer a workplace violence injury. Bureau of Labor Statistics data suggest the…