The Centers for Medicare & Medicaid Services (CMS) this week released new data fueling a narrative of rampant broker fraud on the Affordable Care Act (ACA) exchanges. Plans received data finding 23% of enrollees did not have a claim in 2019. That number jumped sharply to 35% last year. Before the pandemic, the data were largely consistent across three categories: members on...
CMS is proposing a five-year experiment that would allow state Medicaid programs and Medicare Part D plans to cover GLP-1s for weight management on a voluntary basis, according to an Aug. 1 report from The Washington Post. Ozempic, Wegovy, Mounjaro and Zepbound would be included in the program, along with Eli Lilly’s oral GLP-1, Orforglipron, if it’s approved next year.
Nonprofit health system Texas Health Resources has sued the Blue Cross Blue Shield Association (BCBSA) and its entities for entering into agreements to limit reimbursements to providers since 2008. The plaintiffs, in the 179-page lawsuit filed this week, allege horizontal market allocation and price-fixing by geographically restricting how many Blues plans do business in each...
A recent empirical analysis of hospitals’ physician practice acquisitions and employment is the latest to suggest provider consolidation has brought an increase in prices. The working paper analysis, published this month by the National Bureau of Economic Research, focuses on the window between 2008 and 2016 when the share of physicians integrated with a...
The Centers for Medicare & Medicaid Services’ annual pay rate proposal for outpatient and ambulatory surgical centers (ASCs) includes a step toward site-neutral payments, a broader list of services eligible for outpatient reimbursement, updates to hospital price transparency rules and several quality rating methodology updates.
A new study suggests that the introduction of a real-time prescription benefit tool did not lead to meaningful changes in prescription spending or medication use among Medicare Advantage beneficiaries during its first year of implementation. The analysis, published inJAMA Network Open, examined more than 2.8 million beneficiaries and compared patients treated with access to the...
A new report from federal actuaries estimates that national health spending will increase by 7.1% in 2025, with spending growth set to outpace growth in the U.S. gross domestic product. The Centers for Medicare & Medicaid Services Office of the Actuary released its annual look at spending projections last week, and they estimate that from 2026 to 2027, healthcare spending...
The Centers for Medicare & Medicaid Services (CMS) has finalized a rule that it says will address "the surge of improper enrollments" on Affordable Care Act (ACA) exchanges as well as take on wasteful spending. Theagency said late Fridaythat there are likely millions of people who were improperly enrolled in ACA exchange plans. The CMS said 5 million people may have...
The inclusion of Medicare Advantage data in hospital quality reporting, mandatory participation in a bundled payment model and, of course, annual pay increases were common refrains among hospital groups submitted feedback on the administration’s proposed Inpatient Prospective Payment Systems (IPPS) rule for fiscal year 2026. Public comments on...
The National Institutes of Health is seeking comment from industry on a new artificial intelligence strategy for the agency. Principal Deputy Director of the NIH Matthew Memoli, M.D., announced the RFI at the Coalition for Health AI’s semi-annual meeting at Stanford Medicine on Thursday. The forthcoming plan adds to the pro-AI stance of the administration and to...
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