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UnitedHealth, Anthem Medicare Advantage plans penalized for inadequate spending
The Centers for Medicare and Medicaid Services has blocked four Medicare Advantage plans from enrolling new members in 2022 because they didn’t spend the minimum threshold on medical benefits, with three UnitedHealthcare plans and one Anthem plan faili…
CMS won’t take enforcement action for payer-to-payer data exchange in May interoperability rule
The Centers for Medicare and Medicaid Services has announced that it will not take enforcement action against certain payers for the payer-to-payer data exchange provision of the May 2020 Interoperability and Patient Access final rule until future rule…
Report claims 340B hospitals are leveraging discounts to increase profits from cancer drugs
Certain safety net hospitals are charging insurers an average of 3.8 times more than the acquisition costs for oncology drugs, although depending on the drug, the markup can be much higher — up to 11 times the purchase price, a new report has found.
DOJ: Independent Health, DxID allegedly inflated MA reimbursement through unsupported diagnosis codes
Insurer Independent Health and a subsidiary, DxID, are under fire from the U.S. Department of Justice for allegedly submitting unsupported diagnosis codes to inflate Medicare Advantage reimbursements.
The alleged violation of the federal False Claims A…
Cityblock Health, Tufts Health Plan offering personalized care to One Care members in Massachusetts
Value-based care provider Cityblock Health, which focuses on Medicaid and lower-income Medicare beneficiaries, has expanded its collaboration with Tufts Health Plan to offer personalized medical, behavioral and social care to Tufts Health Unify members…
Blue Cross NC, UNC Health team on study to improve food security, chronic health
There are numerous issues that can cause food insecurity, ranging from high medical costs to social isolation, and one major insurer has set aside funding for a large-scale clinical study it hopes will help to address food insecurity among its at-risk …
Linking U.S. prescription drug prices to those paid in other nations could cut costs in half
High prescription drug prices have important implications for the American healthcare system, driving up overall costs.
Premier, others urge HHS to move forward on alternative payment models to achieve equity
The organizations recommended HHS build in flexibilities and payment for APM participants to strengthen their focus on addressing inequities.
HHS Secretary Xavier Becerra releases proposal to lower prescription drug costs
The underlying principles behind the plan, according to HHS, are competition, innovation and transparency.
Shifting common outpatient procedures to ASCs shows cost savings
Hospital outpatient departments perform routine procedures and surgeries such as colonoscopies and cataract removals for commercially insured individuals at substantially higher prices than Ambulatory Surgery Centers, according to new findings publishe…
