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Send us your nominations for Fierce 15 awards
Do you know an influential startup that’s flying under the radar? Tell us how they are changing the healthcare industry as we know it by Nov. 15 for consideration in our Fierce 15 awards.
Telehealth company HealthRight charged in $1B fraud scheme
The CEO of the telemedicine company HealthRight was charged alongside several compounding pharmacies for a $1 billion fraud scheme that charged insurers for marked-up pain creams and marketed millions in bogus supplements to patients.
Trump administration revisits moral and religious exemptions for birth control coverage
A final rule sent to OMB on Thursday resurfaces a contentious regulation that loosened “moral exemptions” for birth control coverage under the ACA. The rule could lead to a new round of legal challenges after several courts halted last year’s rule.
Verma: CMS is exploring ways to expand site-neutral payments
CMS Administrator Seema Verma said the agency is looking at site-neutral payments “across the board,” adding that she is “very interested” in exploring the post-acute space where payment differentials are quite large.
Verma: CMS is exploring ways to expand site-neutral payments
CMS Administrator Seema Verma said the agency is looking at site-neutral payments “across the board,” adding that she is “very interested” in exploring the post-acute space where payment differentials are quite large.
Experts say antifraud laws are holding back rural health
Two longstanding laws designed to limit fraud are becoming problematic for rural health providers, experts told lawmakers during a Senate subcommittee hearing on Tuesday. Changes could ease digital health adoption and help with physician recruitment.
Omada Health made its name with its technology. Now it’s luring insurers with operational innovation
Even Omada Health’s CEO Sean Duffy half-jokingly refers to the company as a provendor—a reference to the digital health company’s high tech roots melded with the billing approach of a provider (complete with an NPI). The identity has caused headaches f…
Federal court nixes CMS overpayment rule, handing a big win to Medicare Advantage insurers
On Friday, a D.C. judge invalidated a 2014 rule that required Medicare Advantage insurers to report and return overpayments associated with incorrect diagnosis codes. The ruling could have a huge impact on an ongoing case against UnitedHealth and a fed…
Montana Health Co-op notches a victory in lawsuit over cost-sharing subsidies
With all eyes on the ACA lawsuit in Texas, a federal judge issued an important victory for insurers over the fate of cost-sharing reduction payments. The DOJ is likely to appeal the decision.
House leaders ask PBMs to explain their impact on downstream drug costs
Congressional leaders in the House Energy and Commerce Committee sent letters to seven PBMs with detailed questions around list price negotiation and how their role in the supply chain impacts spending in federal health programs.
