340B claims data requirements put hospital discounts under stress
Provider advocates criticized Eli Lilly for ramping up pressure on hospitals to comply with a new policy regarding claims submission in the 340B Drug Pricing Program. The drug manufacturer said holdout hospitals will lose 340B discounts on all Lilly products unless the hospitals quickly comply with a mandate issued earlier this year to submit claims…
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…
DOJ brings antitrust lawsuits challenging hospital contracting practices
June 4 update NewYork-Presbyterian responded to the lawsuit brought by the U.S. Department of Justice alleging anticompetitive business practices in the organization’s contracting with insurers (see the original story below). The health system is arguing for a dismissal of the government’s case. Partially echoing OhioHealth’s defense against similar allegations, NYP said the contractual provisions at…
DOGE releases (then removes) Medicaid billing data to expand fraud oversight (updated)
The Trump administration’s ongoing push to address fraud in government healthcare programs includes the release of a massive data set showing Medicaid billing patterns of individual providers. With more than 227 million rows of Medicaid fee-for-service and managed-care billing data and roughly 1.8 million national provider identifiers (NPIs), the file shows the NPI for each…
Consequences of new MA and ACA Marketplace regulations
Nick and Shawn discuss regulatory changes coming from CMS for the 2027 regulatory season.
Hospitals face multiple financial hits from new HOPD requirements
Health systems face multiple potential financial hits from new off-campus HOPD reporting requirements. Also, this week’s Weird Number: 3%-5%. That the amount of net revenue lost annually by electronic health records and billing systems. One More Thing: Healthcare cost concerns could be a big factor in this year’s mid-term election. A survey indicates it could…
Updated documentation requirements in Medicare could add burden on healthcare providers
Citing concerns about improper payments, CMS issued a regulatory update that expands Medicare prior authorization and other documentation requirements starting April 13. The regulations are most meaningful for vendors of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), but the operations of hospitals and other front-line providers stand to be affected as well. Increased documentation…
New administrative mandate for hospitals signed into law as part of FY26 appropriations
Note: The headline and lead section of this article were updated with news that Congress passed the appropriations bill. The FY26 appropriations bill signed Feb. 3 by President Donald Trump leaves hospitals with two years to prepare for a new administrative obligation pertaining to off-campus outpatient departments (OPDs). The package, which passed the Senate last…
The shutdown continues, plus the latest on 340B
HFMA Senior Editor Nick Hut and HFMA Policy Director Shawn Stack discuss the latest in healthcare finance news.
Healthcare fraud enforcement ramps up in the Trump administration, with implications for all stakeholders
Even as hospital leaders consider how to manage decreased reimbursement and higher costs, federal fraud enforcement continues to have some of the most significant financial stakes of any healthcare industry issue. Rather than taking a hands-off approach, the Trump administration is maintaining and even expanding the Biden administration’s push in this area. Two months ago,…