Health Care Dive (Page 2)

Despite major financial struggles, some providers at a physician group in Washington, D.C. say their new — and much larger — parent is not offering the lifeline they want.

The trust fund underpinning Medicare’s hospital benefit is set to run out of money one quarter earlier than previously expected as tax cuts in the GOP’s reconciliation legislation shrink Medicare’s revenue.

A spokesperson said the layoffs were primarily in non-clinical or member facing roles.

Dr. Willie Underwood III said he would focus on uniting physicians across specialties and advancing equity in medicine as president.

It’s another sign of lawmakers’ concern about the pilot, which has been lambasted for delaying care to seniors.

AHIP argued the survey, which was commissioned by a pro-hospital advocacy group, is a blatant attempt by hospitals to deflect the blame for ever-higher spending.

Nearly 60 clinics have closed or consolidated with another site since last year, according to the report.

The rollout marks the second wave of deployments in 2026 after the VA largely paused the project for years to fix technical issues and errors.

The rollout marks the second wave of deployments in 2026 after the VA largely paused the project for years to fix technical issues and errors.

A federal judge ruled that the fee amounted to an unlawful tax on the visa program for highly skilled workers. Medical groups cheered the decision.

The state said it intends to divvy out new contracts, which represent tens of billions of dollars in revenue for each awardee, to six insurers. Winners are mostly incumbents, except for Humana.

City leaders said the regulation risks undermining the Affordable Care Act exchanges and adding new costs for local governments. Now, they’re suing to overturn the rule.

Many enrollees don’t know they’ll need to report work, education or volunteer hours starting in less than six months in order to stay covered, according to a recent survey from the Health Management Academy.

Americans are increasingly frustrated about being blocked off from care, which results in worse health outcomes and financial stress, per the new study. Still, insurers generally defend their claims review processes and argue improper denials aren’t their fault.

Regulators cleared the nonprofit’s $3.9 billion AmSurg acquisition — but with conditions.

The EHR vendor accused SelfRx of retrieving over 100,000 records for financial gain in the high-profile lawsuit. Now, the chronic condition management firm said it doesn’t know who took the records.

Many adults are sharing device data with providers too. But users are typically healthier and wealthier, suggesting people who could benefit the most from health monitoring are less likely to adopt the tools, according to Rock Health.

The advanced model should support earlier and more accurate diagnoses and treatment planning, the companies said.

Rising costs are eroding Americans’ trust in their commercial plans despite an industry-wide push to increase consumer satisfaction, the analytics firm found.

Ardent elevated its former COO, Dave Caspers, to the top job as the Tennessee-based system grapples with its declining stock price.

Ascension needs to sell seven surgery centers if it wants the deal to close, regulators said. Ascension, which is pursuing the AmSurg acquisition as part of a larger financial turnaround, said it was pleased with the compromise.

Select hospitals have refused to share data to prove they’re not double-dipping drug discounts, Lilly said. The drugmaker is giving them until Monday to comply or lose out on 340B savings altogether. Hospitals urged the government to intervene.

Nearly three-quarters of clinicians said losing critical thinking or decision-making skills will be one of the greatest risks of adopting artificial intelligence, according to a survey by Wolters Kluwer Health.

The highly anticipated interim final rule weighs in on key issues for states hustling to operationalize work requirements before the 2027 deadline. But there’s still some gray area — and lots of critics.

The attorney general said the civil penalties could add up to “multiple millions” if the suit is successful.

The state claims UnitedHealthcare inflated the sickness of seniors enrolled in MassHealth managed care plans to reap at least $100 million in improper payments.

As CFOs confront rising healthcare costs, thinking hard about worker retention and where costs can be made more efficient is essential, Virta’s Manu Diwakar said.

The percentage of Americans without insurance last year remained relatively flat compared to 2024. However, more people are likely to lose coverage in the years to come due to healthcare spending cuts from the “Big Beautiful Bill.”

A highly anticipated rule finalized Thursday meaningfully improves how insurers and providers settle disputes over out-of-network bills. But payers say it doesn’t go far enough to curb alleged provider abuse.

The resources aim to offer a standard but flexible framework for health systems, regardless of their size or available resources, the industry group said.

Dr. Roy Schoenberg, who founded the telehealth company Amwell with his brother two decades ago, will become the new head of Amazon’s healthcare unit on July 1.

The industry has been waiting for regulators to finalize the rule amid snowballing concerns about how insurers and providers settle out-of-network claims. The regulation is aimed at making that process more efficient.

UHS will establish a new nonprofit to absorb financial responsibility of GW University’s debt-ridden physician practice group. Executives told Healthcare Dive the deal should help stabilize those clinical operations in the D.C. region.

UHS will establish a new nonprofit to absorb financial responsibility of GW University’s debt-ridden physician practice group. Executives told Healthcare Dive the deal should help stabilize those clinical operations in the D.C. region.

The agreement includes Lilly’s new pill Foundayo and restores coverage for Zepbound, erasing what had been a commercial edge for rival Novo Nordisk.

It’s the fourth federal court in six weeks to reject insurer attempts to relitigate No Surprises determinations, HaloMD said. The dismissals have thrown cold water on insurers’ efforts to contest what they say is rampant fraud under the law.

Eva Boratto, who spent more than a decade at CVS in a variety of finance roles, will join the drug distributor later this summer, Cencora announced Wednesday.

The law, which would prohibit PBM conglomerates from owning or operating pharmacies, illegally boots out-of-state companies from Tennessee’s pharmacy market, CVS argued in a suit filed Friday.

High costs and other stressors have made it difficult for the regional nonprofit to continue offering coverage, the company said. About 42,000 members will be affected by PacificSource’s exits.

The smart ring maker’s filing follows a recent $900 million fundraise and comes amid plans to develop more health features for the device.

Healthcare workers were more likely to mention burnout in Glassdoor reviews than those in other sectors, the company said.

Hospitals affiliated with Mount Sinai, the University of Michigan and the University of Kansas allege that CVS artificially deflated reimbursement for 340B drugs for years, causing them to lose out on savings.

The department will use AI to examine audits from states and other federal grant recipients, and potentially withhold funds if they aren’t able to fix errors.

The rural health-focused system has struggled to find its footing ever since spinning off from Community Health Systems a decade ago. Now, Quorum is hoping that a pivot to nonprofit status is the answer.

However, data was limited, so it’s too early to make firm conclusions, the watchdog clarified. That didn’t stop the largest PBM lobby from jumping on the report as concrete proof that consolidation doesn’t drive up prices.

Physician pay hasn’t kept up with the costs of providing care, pushing independent practices to sell to health systems and likely increasing costs, witnesses said during a House subcommittee hearing Wednesday.

The proposed rule codifies cuts outlined in the GOP’s “One Big Beautiful Bill,” but also takes other steps to restrict supplemental Medicaid payments. The CMS said it would save the federal government over $500 billion if finalized.

The healthcare AI company said San Oo’s appointment comes at an inflection point for Abridge as it inks deals with more health systems.

The nonprofit giant has offered health insurance for decades. But recent challenges, including higher costs and regulatory changes, have placed Providence in an untenable position, according to the integrated system’s CEO.

A fuller picture is emerging of how the expiration of enhanced subsidies is affecting the Affordable Care Act exchanges and the millions of Americans who rely on them for coverage.

The civil rights enforcement arm of the HHS will reinstate a division dissolved during the Biden administration that focuses on conscientious objections and religious issues in health and social programs.

Lawmakers introduced a resolution to end the WISeR model, which Democrats say is delaying and denying seniors care.

Recent enforcement involving COVID-19 vaccines appears to go hand in hand with the Trump administration’s broader prioritization of Christian issues.

The Tenet-owned hospitals want Leapfrog to pay $10.5 million in legal fees after a judge agreed that the nonprofit unfairly deflated their ratings. The penalty would “cast a specter of financial ruin” over the nonprofit, Leapfrog said.

The Catholic nonprofit giant’s expenses well outstripped revenue in the most recent financial quarter. Though the outcome was mostly due to one-time items, CommonSpirit also continues to struggle with boosting core operations.

Tenet wants Leapfrog to pay $10.5 million in legal fees after a judge agreed that the nonprofit unfairly deflated Tenet’s hospital ratings. The penalty would “cast a specter of financial ruin” over the nonprofit, Leapfrog said.

Nathan Frank discusses how the insurer is using AI to engage members, how the company thinks about risks, and the importance of monitoring the tools and soliciting feedback.

The study highlights “a significant disconnect between how employers believe they are supporting employees and how employees say they feel,” Prudential Financial said.

Providers are reaping high award amounts, and arbiters have “structural conflicts of interest” that incentivize a high volume of disputes, driving up healthcare costs for employers and patients, the groups wrote.

The Trump administration continues to open the doors to the cheap, high-deductible coverage, to the worry of insurance experts and stakeholders in the healthcare industry.

The ruling maintains access to mifepristone while litigation continues. The drug can still be prescribed at pharmacies or by mail without requiring in-person visits.

The effort, part of the agency’s ambitious Health Tech Ecosystem, aims to accelerate the industry’s progress before requirements on electronic prior authorization go into effect next year.

The Labcorp agreement continues the expansion of Aura, which gives healthcare providers access to tests from companies including Quest Diagnostics.

Dr. Tomislav Mihaljevic’s appointment comes months after Oracle named another healthcare leader, former Quest Diagnostics CEO Stephen Rusckowski, to the board as the technology giant expands its reach in the sector.

Only 33% of physicians surveyed by the American Medical Association said they believed voluntary pledges made by major insurers last year to reform prior authorization would result in any meaningful difference to the industry.

The agency is halting enrollments for six months as part of the Trump administration’s broader attempt to crack down on fraud in government healthcare programs. Hospice and home health groups said they largely supported the moratorium.

Dr. Gianrico Farrugia has led the system since 2019. The Rochester, Minnesota-based health system said it could elect Mayo’s next leader in November.

More than 90% of employers agreed a rebate-free approach is easier to understand and would improve drug price transparency, according to the survey conducted for Evernorth, which operates a pharmacy benefit manager.

Makary’s exit ends a turbulent run marred by leadership upheaval, mass layoffs, political pressure and public spats with drugmakers.  

The proposal addresses a key plank in President Donald Trump’s labor agenda and would exempt fertility benefits from the requirements of some federal health coverage laws.

Strikes at Kaiser, including a monthlong work stoppage among 31,000 nurses and other employees, added to the nonprofit health system’s rising expenses in the first quarter, which dinged its operating margin.

The influential advisory group is recommending policies to boost human oversight and visibility into how Medicaid plans are using the technology, in a bid to prevent risks like inaccuracies or data bias.

“Remove healthcare from the equation, and the US labor market is actually losing more than it is gaining,” one economist said.

The deal comes months after an acquisition by travel nursing agency Aya Healthcare collapsed.

Elizabeth Schwartz will head up government relations at the for-profit hospital trade association as health systems brace for federal funding cuts.

The findings suggest hospital at home could serve as a safe alternative to inpatient care, researchers wrote. However, adoption is uneven, with most programs located in urban areas.

Interruptions in the supply of neurosurgical patties, sponges and strips are expected to continue through 2026.

The healthcare giant increased its adjusted earnings guidance for 2026 by more than 4% as CVS saw “substantial improvement” in its health benefits segment, CFO Brian Newman said on an earnings call.

Nearly 8 in 10 reported the expensive weight loss medications are increasing their company’s healthcare costs, according to a survey by the Business Group on Health.

Heather Cianfrocco is joining the Pittsburgh-based healthcare company as its COO effective immediately.

CEO Kevin Lobo said the attack had a “big impact” on first-quarter results. However, the company maintained its full-year guidance.

The sector recorded 12 bankruptcy filings in the first quarter, up 33% from the fourth quarter of 2025, according to the analysis by Gibbins Advisors.

On Monday morning, the Supreme Court paused a lower court’s decision that effectively banned the mailing of mifepristone, after makers of the abortion drug asked the nation’s highest court to intervene.

The strike force allows the department’s healthcare fraud unit to coordinate with U.S. attorney’s offices in Arizona, Nevada and the Northern District of California, where the DOJ says fraud schemes are increasing.

Most states are planning to adopt less restrictive policies to verify compliance with work requirements mandated by the “Big Beautiful Bill” passed last year, but some are implementing the policies early or checking eligibility more frequently. 

The agency kept a contested definition of “professional” student that excludes fields like graduate nursing and physical therapy from higher loan caps. Healthcare groups say the regulation could worsen workforce shortages.

The Cornhusker State is the first to roll out work requirements under the GOP’s “Big Beautiful Bill,” well in advance of the law’s 2027 deadline. Between 20,000 and 40,000 people are expected to lose Medicaid as a result.

Executives said Tenet’s focus on managing expenses and growing high-acuity service lines helped it withstand poor volumes that battered some of its peers in the first quarter.

The insurer plans to say goodbye to the ACA exchanges after this year, and is exploring a potential sale of its controversial claims review subsidiary. Both businesses were more trouble than they were worth, executives said.

Healthcare organizations are struggling to navigate the compliance landscape amid a pullback in federal enforcement, a wave of state legislation and emerging voluntary initiatives, experts say.

During a high-profile congressional hearing on Tuesday, one lawmaker said hospitals charge “an insane amount” for care. Still, the CEOs largely passed the buck, arguing their prices are justified.

Native, Hispanic and Black communities experienced worse health access and affordability issues than white people in most states, according to a new report from the Commonwealth Fund.

Humana’s foremost priority is returning to 3% Medicare Advantage margins in 2028, CEO Jim Rechtin repeatedly promised investors on Wednesday morning. Still, the insurer’s profits dipped in the first quarter.

The risk of being sued is higher among certain specialties like surgeons, and increases the longer doctors practice medicine, according to the medical association’s new report.

The insurer, a mainstay in government programs like Medicaid and the ACA exchanges that have been wracked by higher spending, successfully controlled costs in the quarter, leading to $1.5 billion in profit.

The hit was in line with HCA’s expectations. The hospital operator is the first of its peers to detail financial impacts from the expiration of more generous subsidies in Affordable Care Act plans.

Aligning electronic data submission requirements for prior authorizations is one prong of the insurance industry’s commitment to reform the unpopular preapprovals.

The private equity-backed anesthesia provider bought and bullied its way to market dominance in Texas, driving up prices for patients, the FTC alleged. The parties have now reached a deal, though USAP will not admit liability.

The report compiled by Sen. Maria Cantwell, D-Wash., found procedures in the state that were previously approved within around two weeks now take four to eight weeks to be authorized.

Though chatbots could have some benefits for mental health access, the physician lobby argued “immediate attention is required” to avoid harming patients looking for support.

The pathway is designed to reduce the delay between FDA authorization and Medicare coverage for certain Class II and Class III breakthrough medical devices.

The insurer beat analyst expectations for adjusted earnings in the first quarter. But steeper Medicaid membership losses than expected could saddle Molina with higher costs down the line.

The data, compiled by the Brookings Center on Health Policy, shows that average prices for some services like imaging were seven-times higher than Medicare prices.

A program that got caught up in HHS’ decision to abandon mRNA research was revived by a public-private coalition and is now beginning a large, late-stage test that could support a future approval.

A program that got caught up in HHS’ decision to abandon mRNA research was revived by a public-private coalition and is now beginning a large, late-stage test that could support a future approval.

The company argues the offering is a more comprehensive approach to weight management, allowing patients to receive ongoing support care and transparent pricing on prescriptions.

The retailer, which at one point had 14 MedWise sites, is divesting its nine-location network to Saint Francis Health System.

Hospitals and clinics told regulators that switching to rebates in the 340B drug discount program would impose costs that would outweigh the program’s benefits.

Hayley Park will oversee BSCA’s prescription drug programs. The insurer has worked to overhaul its pharmacy management model in a bid to lower drug costs.

Premium hikes, plan redesigns and other efforts from the Minnesota-based company to wrangle medical spending bore fruit in the first quarter. UnitedHealth’s stock jumped accordingly.

The influential physician association surveyed thousands of doctors and found that burnout last year was lower than in 2024 or 2023. Still, certain specialties, especially those on the front lines of care, face an elevated risk of burning out.

Republicans largely praised the HHS secretary’s track record during a marathon of House hearings last week, but some GOP lawmakers raised concerns about proposed budget cuts to the National Institutes of Health.

Employers, lawmakers and more said regulators should hustle to get disclosure mandates for the controversial drug middlemen across the finish line, while PBMs slammed the rule as illegal, unnecessary and anticompetitive.

The agency said it developed concerns about the limited evaluation process for the devices after gaining experience with the alternative pathway.

If confirmed by the Senate, Schwartz could finally fill a void for an agency that’s cycled through multiple leaders over the last year.

The AI scribe company said information from the New England Journal of Medicine and the JAMA Network will allow providers to more easily access the latest medical research.

About 14% of ACA enrollees didn’t pay premiums in January, a higher rate than usual and one that suggests ACA enrollment will continue to decline, according to Wakely.

Healthcare affordability continues to keep employers up at night. More businesses are shopping for new healthcare vendors as a result, according to the Purchaser Business Group on Health.

The agency’s decision to hold an advisory committee meeting on the topic comes after HHS Secretary Robert F. Kennedy Jr. told podcaster Joe Rogan he’s a “big fan” of peptides.

Customers can now connect to third-party providers for weight management services through Walmart’s digital health platform, then turn around and fill GLP-1 prescriptions at its retail pharmacy.

Study authors, who reviewed data from New York, said rising rates of overturned claims suggest that insurers’ claims review processes might not be working as intended, and policymakers should consider getting involved.

Dr. Janice Nevin will step down in September after more than 12 years in the health system’s top role. ChristianaCare’s former chief legal counsel will take her place.

The rollout marks the first deployment of the records system at a VA medical center in years after technical problems plagued the project. In total, 13 medical centers are scheduled to receive the Oracle EHR in 2026.

When workers delay care because of cost, it could hurt employers more in the long run, other research suggests.

It’s a major victory for controversial billing intermediary HaloMD, which cheered the court’s decision. Elevance said it plans to appeal.

Participants will receive set reimbursement for managing Medicare beneficiaries’ chronic conditions, like diabetes, chronic kidney disease and hypertension.

Paola Arbour will stay at Tenet on a part-time basis to provide transition and support services through early 2028.

Drugs were left out of a 2024 rule streamlining prior authorizations by making decisions electronic and requiring payers to turn them around more quickly. The Trump administration is looking to address that gap.

Regulators are proposing to send $1.4 billion more to acute care hospitals and debut the first nationwide, mandatory payment model to lower the cost of joint replacements. Hospitals pushed back.

The agency showcased dozens of tools Thursday, about 8 months after the CMS first announced the initiative that aims to ease health data sharing and improve access to digital health and AI products.

Persistent barriers are still hindering drug development for a host of menopause symptoms.

A group of 19 states and Washington, D.C., sued over the department’s sweeping layoffs and reorganization last year. A federal judge on Tuesday struck down the HHS’ bid to dismiss the lawsuit.

The telehealth provider said hackers gained access to a third-party customer service platform, but medical records remained secure.

About 2 in 10 said they at least sometimes use AI chatbots to get health information, but only 18% considered their responses highly accurate, according to the survey published by the Pew Research Center.

A resilient medtech industry navigating the fallout from President Donald Trump’s trade wars is taking proactive steps to manage tariff costs as the administration’s policies continue to evolve.

The health system claims the policy, which reduces reimbursement for some inpatient hospital stays, violates federal law and its reimbursement contract with Aetna. The insurer disagreed with Jefferson’s allegations.

Employers are turning to Individual Coverage Health Reimbursement Arrangements to cut costs, but rising premiums and instability on the individual market pose challenges.

Companies raised $4 billion in the first quarter, an increase of $1 billion over the prior year, according to Rock Health. But nearly 60% of the capital deployed came from 12 large deals.

The Trump administration is requesting about $111 billion in discretionary funding for the HHS, nearly $16 billion less than its budget in 2026.

Regulators cut almost a dozen metrics that factor into the quality ratings and reverted back to an older and more generous bonus system. MA plans will get more than $18 billion in additional payments over the next decade as a result.

Lawmakers are considering bills that would unwind the state’s oversight over Ballad, the largest state-sanctioned hospital monopoly in the U.S. The FTC argues that’s a bad idea.

Clinicians’ use of an AI scribe was associated with 13 fewer minutes each day inside electronic health records and 16 fewer minutes on documenting patient care, according to the research published in JAMA.

The insurer had until the end of March to correct faulty data submissions or be hit with severe sanctions from the CMS. But regulators agreed to give Elevance more time to comply.

Hospitals in 16 states have sued the department, arguing a 2023 final rule underpays hospitals that treat a disproportionate number of low-income patients.

Senators praised a recent CMS proposal aimed at reducing payments in MA, but urged the agency to work with Congress and go further.