Healthcare Dive

Regulators recalculated plans’ quality scores last month after losing a lawsuit to Clover Health. But they used a different methodology for Clover than its peers, causing Elevance to lose out on $115 million, the insurer told a court.

Fewer companies may be impeding the flow of digital health information, but some could be doing so frequently, the ONC said. 

The deal brings Highmark Health-owned AHN’s hospital count to 16. The combined system will invest about $285 million over the next decade to bolster Heritage Valley’s facilities.

The rule, released Thursday, builds on Trump administration’s priorities, including cutting Medicare reimbursement for drugs in the controversial 340B program and equalizing payment between sites of care.

Medicare is spending more on quality bonuses despite fewer enrollees in eligible plans, the health policy research group said — a concerning trend putting more stress on Medicare’s coffers that could amplify calls for reform.

Millions of people could meet criteria to receive GLP-1s, which could cost Medicare billions of dollars, according to a report by KFF.

Steve Walsh, the CEO of a Massachusetts hospital group, will assume the top role in the early fall, after the AHA’s longtime leader Rick Pollack retires.

Express Scripts, Caremark and Optum Rx sued the FTC after the agency accused them of driving up the cost of insulin. But the countersuit is being put to bed now that the PBMs are settling with regulators.

Following Vijay Kumar’s exit, acting CBER Director Karim Mikhail will also oversee a review office that has become a battleground for debates on FDA flexibility.

Twenty-six states are seeking to overturn some of the regulation released by the CMS this month that outlined Medicaid work requirements — and asking the court to pause implementation for the time being.

The cardiac monitoring company said that a threat actor has demanded payment in exchange for not publicly releasing the stolen data.

Express Scripts and the PBM lobby are following in CVS Caremark’s footsteps in filing complaints challenging the FAIR Rx Act, which was passed earlier this year despite vehement opposition from PBMs.

The proposed change adds Medicare coverage for beneficiaries with asymptomatic severe aortic valve stenosis who are enrolled in a CMS-approved study.

Most of Centene’s 61,000 employees will be eligible to apply for voluntary separation. But the program doesn’t amount to a complete overhaul of the company, a spokesperson said.

For 2029, a federal rule proposes closing a "loophole" that protects medicines transitioning from intravenous administration from price protection.

Friday’s decision is a victory for insurance advocates. But, given many of the rule’s provisions were codified in the GOP’s “Big Beautiful Bill,” it’s not a panacea for the ACA.

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The tentative deal comes months after CVS Health reached a proposed settlement in the lawsuit alleging major pharmacy benefit managers are inflating insulin costs.

MA insurers commonly deny requests for post-acute care — but none more frequently than UnitedHealth, Humana and CVS, the HHS OIG said. Insurers were not happy about the findings.