The American Civil Liberties Union called the ruling “a major victory for public health.” Federal officials are exploring their legal options, including an appeal.| Healthcare Dive
The Government Accountability Office can file a lawsuit in an attempt to restore the grants. However, the agency has not opted to do so during the second Trump administration.| Healthcare Dive
Centene continued to deal with a mismatch between Medicaid rates and patient acuity in the second quarter, but still exceeded Wall Street’s expectations thanks to Affordable Care Act growth.| Healthcare Dive
Conservative planning and continued business growth helped Molina keep an ongoing mismatch between payment rates and member acuity from dinging its bottom line in the third quarter.| Healthcare Dive
The insurer shrank its plan footprint for 2025 in a bid to improve margins. Now, Humana is giving market watchers loose guidance into how that reduction could affect its enrollment along with second quarter results.| Healthcare Dive
CenterWell said it will lease space at Walmart Supercenter stores in four states.| Healthcare Dive
Financial challenges at rural hospitals — driven by reimbursement problems — are leading facilities to shutter labor and delivery wards, the report found.| Healthcare Dive
One challenge hospitals face is reimbursement from private payers, which doesn’t cover the higher costs of care in rural areas, according to a report by the Center for Healthcare Quality and Payment Reform.| Healthcare Dive
Dually classifying allows urban facilities to benefit from rural health programs, even as many rural facilities struggle financially and are at high risk of closure, researchers wrote.| Healthcare Dive
Top executives of CVS Caremark, Optum Rx and Express Scripts made a rare congressional appearance to defend pharmacy benefit managers’ drug pricing policies.| Healthcare Dive
Pharmacy benefit manager lobby PCMA and drugmaker lobby PhRMA pointed fingers over problems in the prescription supply chain during the House committee's second PBM hearing on Tuesday.| Healthcare Dive
Antitrust regulators are poised to file suit against CVS Caremark, Express Scripts and Optum Rx over how they negotiate discounts for drugs, including insulin, according to the report.| Healthcare Dive
The report is not positive for the drug middlemen, which immediately criticized it as one-sided.| Healthcare Dive
The major PBM said its lawsuit is necessary to protect against misinformation about the controversial drug middlemen, while the FTC promised to defend its research.| Healthcare Dive
The Cigna-owned pharmacy benefit manager colluded with rival Prime Therapeutics to overcharge pharmacies, according to a lawsuit filed last week.| Healthcare Dive
Pharmacy benefit managers have largely avoided the brunt of public blame for the deadly opioid crisis. Arkansas’ lawsuit brings the drug middlemen back to the forefront of the controversy.| Healthcare Dive
Major pharmacy benefit managers continue to double down on specialty as a reliable source of business amid a growing crop of pharmacy upstarts.| Healthcare Dive
Worries about higher-than-expected medical spending have reached Medicaid, as redeterminations spark turbulence in the program.| Healthcare Dive
A coalition of 16 states and Washington, D.C. argue the Trump administration is trying to ban youth gender-affirming care without going through Congress.| Healthcare Dive
Only 25% of Humana members will be in plans with four stars or above next year, down from 94% this year, the insurer disclosed last week. The downgrade could wipe out Humana’s profits in 2026.| Healthcare Dive
The insurer has recorded $2.5 billion in total impacts from the attack through the nine months ended Sept. 30, according to UnitedHealth’s third-quarter earnings.| Healthcare Dive
Despite challenges in Medicaid and MA, major insurers still posted large earnings in the second quarter — many helped by health services divisions.| Healthcare Dive
The insurer said it doesn’t expect earnings growth next year due to significant investments it plans to make to boost MA stars.| Healthcare Dive
Like other payers, Centene flagged a mismatch between patient acuity and payment rates in Medicaid. But the insurer said a diversified portfolio helped it navigate challenges in the third quarter.| Healthcare Dive
The agency brought action against Caremark, Express Scripts and Optum Rx, arguing their “anticompetitive and unfair” rebating practices “artificially inflated” the list price of life-saving insulin drugs.| Healthcare Dive
Elevance beat Wall Street expectations in second-quarter results posted Wednesday, despite steep Medicaid membership losses that are affecting revenue forecasts.| Healthcare Dive
Executives said the increased costs pressuring its Medicaid business would improve after states updated payment rates to better match member acuity.| Healthcare Dive
Researchers suggested that policymakers encourage reinvestment of capital into patient care and limit share buybacks based on the findings.| Healthcare Dive
In the third quarter, the seven major publicly traded insurers’ medical loss ratios increased an average of 3.3 percentage points year over year — a major jump in medical costs.| Healthcare Dive
The insurer also reported notable ACA growth for this year, though membership could tick back down through the second quarter due to program integrity efforts.| Healthcare Dive
Brian Thompson’s death set off a flood of darkly celebratory social media posts offset by solemn remembrances from his peers and other healthcare leaders.| Healthcare Dive
UnitedHealth’s net income plummeted to its lowest level since 2019 amid hefty costs, including some from the Change cyberattack. CEO Andrew Witty also remembered slain executive Brian Thompson on a Thursday morning call.| Healthcare Dive
After a turbulent year, things should calm for payers with the advent of a business-friendly Trump administration — though challenges will persist. Here are experts’ biggest predictions for 2025.| Healthcare Dive
In a call with investors, CEO Gail Boudreaux didn’t directly address the killing of UnitedHealthcare’s top executive but spent more time than usual arguing Elevance is working to improve healthcare.| Healthcare Dive
The judge’s ruling follows a trial in which the DOJ argued that UnitedHealth’s bid for Change would disadvantage rivals and result in higher costs, lower quality and less innovative commercial health insurance.| Healthcare Dive
The hospital operator said all MyChart features were operational as of Jan. 9, about six weeks after the Thanksgiving attack.| Healthcare Dive
Regulators want payers to issue coverage decisions within 72 hours for urgent prior authorization requests — but the final turnaround time could be even shorter.| Healthcare Dive
Just over half of plans received four stars or more for 2023, a sharp decrease from 68% last year.| Healthcare Dive
Regulators are reportedly looking into the massive healthcare conglomerate’s potential anticompetitive effects, including the relationship between its health insurer UnitedHealthcare and physician network Optum.| Healthcare Dive
The insurer paid vendors to conduct in-home visits with its members, then pressured the vendors to record high-value diagnoses that would lead to higher payments for Cigna, the DOJ alleges.| Healthcare Dive
The figure is almost triple prior estimates, highlighting the need for payment reform to avoid overtaxing the Medicare system, researchers said.| Healthcare Dive
The insurer reported favorable MA inpatient utilization as COVID-19 claims decreased in the first quarter.| Healthcare Dive
Enrollment in the popular plans is expected to continue to grow in 2023, CMS predicts.| Healthcare Dive
The insurer expects its medical loss ratio in the second quarter to reach or exceed its full-year target. UnitedHealth’s stock, along with that of other major Medicare payers, fell in Wednesday morning trading as a result.| Healthcare Dive
Secretary Xavier Becerra urged states to adopt new flexibilities to limit Medicaid churn, adding in a letter to state governors that he's "deeply concerned" about unnecessary coverage losses.| Healthcare Dive
The agreement settles a whistleblower lawsuit against Cigna that the Department of Justice joined last year, and requires the payer to undergo annual auditing from an independent entity.| Healthcare Dive
The transaction exits Cigna from a sector that’s been a huge source of growth for insurers but has seen its earnings potential shrink.| Healthcare Dive
An expected economic downturn has yet to materialize, leading Cigna to say Thursday it plans to add at least 1.6 million members this year, up from previous forecasts.| Healthcare Dive
Lawmakers demanded the operator detail how it will "ensure the communities Steward’s hospitals serve are not abandoned" amid financial troubles.| Healthcare Dive
Regulators have historically struggled to make a case against complex and non-traditional tie-ups. That could change with the new guidelines.| Healthcare Dive
To alleviate other antitrust concerns, UnitedHealth agreed to divest ClaimsXten to private equity group TPG Capital.| Healthcare Dive
The resources serve as a “step forward” as the agency looks to propose enforceable standards, HHS Deputy Secretary Andrea Palm said.| Healthcare Dive
Provider groups applauded the move, but said they’d need to see how the requirements are rolled back before passing judgment on whether the step would ease documentation burdens on physicians.| Healthcare Dive
Risk adjustment changes will now be phased in over three years, after payers pushed back on the proposed payment rule.| Healthcare Dive
Volatility in MA stars for the 2023 plan year is raising questions around the earnings outlooks issued by payers.| Healthcare Dive
Investors on Tuesday got a clearer picture of the cyberattack's financial fallout on the healthcare juggernaut. Some said it wasn't as bad as they'd feared.| Healthcare Dive
The payer, which brings in the bulk of its revenue from Medicare, is fighting a rule finalized earlier this year to claw back overpayments in the increasingly popular MA program.| Healthcare Dive
The insurer said its employer segment no longer meets Humana’s long-term strategic plans.| Healthcare Dive
The insurer also lowered its expectations for Medicare Advantage membership growth this year to below the industry average.| Healthcare Dive
Cigna and Humana are abandoning merger discussions less than two weeks after news of the potential deal dropped, following a less-than-positive market reaction.| Healthcare Dive
While the insurer continues to be rocked by more seniors seeking outpatient care, the fourth quarter also saw high levels of vaccinations and COVID-19 admissions that accelerated spending.| Healthcare Dive
The CMS proposed a 0.2% dip in MA rates. However, analysts said regulators will likely improve the payment rate in the final notice.| Healthcare Dive
Enrollment in MA plans has steadily increased since 2007, when one in five Medicare beneficiaries were enrolled in a private plan.| Healthcare Dive
Despite the uncertainty, the insurer reaffirmed its earnings outlook for 2025.| Healthcare Dive
The insurer on Wednesday joined its peers in slamming proposed MA payment rates as insufficient given the dogged increase in medical costs.| Healthcare Dive
The health insurer sees Medicare Advantage as an area for future growth, despite selling the division for $3.7 billion. Cigna’s CEO called the sale a “win-win” on a call with investors Friday.| Healthcare Dive
On the insurer’s earnings call, analysts peppered Centene with questions about its Medicare Advantage business until its CFO attempted to change the subject.| Healthcare Dive
The health insurer expected to be offered a contract to manage the care of Medicaid seniors in a new long-term services and supports program, but wasn’t able to stand up a dual-eligible special needs plan in time.| Healthcare Dive
The CMS doesn’t require states to report data on outcomes or care denials, and has made “delayed” progress on plans to analyze the information and make it public, according to the Government Accountability Office.| Healthcare Dive
Sen. Ron Wyden, D-Ore., and Rep. Frank Pallone, D-N.J., sent letters requesting information on coverage denials to seven payers, including UnitedHealthcare, Aetna and Centene.| Healthcare Dive
It’s not yet clear how much the new Medicaid managed care contract is worth. The state’s previous contract with insurers, including Centene, allocated $6 billion in funds over five years.| Healthcare Dive
After declining briefly in 2020, family healthcare costs are rising as the industry faces an uncertain macroeconomic environment.| Healthcare Dive
The new guidelines should give regulators sharper teeth in going after vertical and cross-market deals that have historically been difficult to challenge.| Healthcare Dive
The filing marks the largest provider bankruptcy in decades, according to experts.| Healthcare Dive
The physician-led healthcare network formed to save hospitals from financial distress. Now, hospitals in its own portfolio need bailing out after years of alleged mismanagement.| Healthcare Dive
As private equity firms buy up hospitals and staffing agencies, lawmakers say they're increasingly concerned that patient care could suffer.| Healthcare Dive
The study comes as lawmakers and the Biden administration call for more oversight into private equity’s role in healthcare.| Healthcare Dive
The cross-agency investigation comes as scrutiny rises regarding corporate consolidation in healthcare.| Healthcare Dive
The analysis comes as private equity investments in healthcare soar and regulators look to crack down on roll-up acquisitions.| Healthcare Dive
Witnesses at the hearing said system performance has improved, but lawmakers called the persistent outages “unacceptable.”| Healthcare Dive
Providers said the outage at the UnitedHealth-owned technology company has affected billing, eligibility checks, prior authorization requests and prescription fulfillment.| Healthcare Dive
With the release of HealthScribe, Amazon is the latest tech giant to leverage the futuristic algorithms to streamline medical notetaking for physicians.| Healthcare Dive
Both hospital and payer groups came out in support of the rule finalized Wednesday, finding common ground in the need to streamline prior authorization.| Healthcare Dive
Despite heavy lobbying, insurers failed to see MA rates improve in the final rule, which codified a 0.16% decrease to benchmark funding.| Healthcare Dive
All major payers saw elevated utilization but only an unprepared few struggled with the trend, the Change Healthcare cyberattack caused minimal financial fallout and a new D-SNP rule opens the door to a Medicare growth opportunity.| Healthcare Dive
Because of the final rates for next year, Humana will have to enact “larger benefit reductions to achieve stable margins,” its CFO told investors.| Healthcare Dive
The health insurer’s stock plunged Thursday morning following its 2023 results, which fell startlingly short of Wall Street’s expectations.| Healthcare Dive
Hundreds of thousands of seniors could switch plans during next year’s open enrollment, depending on how drastically the MA market giants slash benefits in an attempt to improve profits.| Healthcare Dive
The big question coming out of the health insurance earnings season is how much elevated utilization among seniors is carrying over into 2024.| Healthcare Dive
Meanwhile, Centene, Elevance and Humana held onto statewide contracts. The reprocurement was especially positive for Centene, which had been expected to lose market share, analysts said.| Healthcare Dive
The latest healthcare policy and regulation news for industry professionals| www.healthcaredive.com
The court’s controversial decision raises the bar for healthcare regulators when they’re implementing laws with undefined terms — and opens the door for more lawsuits from stakeholders unhappy with an agency’s reading of a statute.| Healthcare Dive
The Stop Corporate Capture Act would codify the Chevron doctrine, which required federal courts to defer to agencies’ reasonable interpretation of ambiguous statutes.| Healthcare Dive
Agents and brokers connecting consumers with Affordable Care Act plans now have to jump new hurdles to change their coverage, following mounting complaints about unauthorized plan switching.| Healthcare Dive
A majority of the providers affected by the attack last month have regained access to electronic health records, but the system said it is still working to return to normal operations.| Healthcare Dive
Despite the swell of political and media attention to private equity’s role in healthcare, PitchBook reports investment growth in providers has slowed.| Healthcare Dive
Texas Judge Reed O’Connor’s decision suggests he could overturn at least part of the rule, which is meant to curb predatory plan marketing to seniors.| Healthcare Dive
The attack may have exposed data like medical information, payment details and Social Security numbers for a potentially huge swath of Americans.| Healthcare Dive
Generative AI has roared onto the tech scene through the large language model backing ChatGPT. Companies are already deploying the algorithms in hospitals. Should healthcare be taking a pause?| Healthcare Dive