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AHIP president and CEO calls for strengthening Medicare Advantage, Medicaid managed care
Delivering opening remarks during the AHIP 2021 National Conference this week, AHIP President and CEO Matt Eyles called for strengthening and protecting Medicare Advantage as well as Medicaid Managed Care, calling the programs “efficient, effective and…
University of California Irvine receives $30 million gift to construct a medical innovation building
Supported by a $30 million lead gift from the Falling Leaves Foundation, University of California Irvine will move forward with construction of a planned medical research facility on its campus, which is expected to enhance its cross-disciplinary teach…
Prime Healthcare hospitals cut ties with UnitedHealthcare, citing low reimbursement
Prime Healthcare’s New Jersey hospitals announced this week they would terminate their contracts with major insurer UnitedHealthcare, citing significant underpayment compared to the rates of neighboring facilities, and lower reimbursement rates than th…
CDC spending more than $2 billion on infection control and prevention efforts
The U.S. Centers for Disease Control and Prevention has earmarked $2.1 billion from American Rescue Plan funding to improve infection control and prevention across the country — the largest federal investment of its kind to date, the agency said.
CMS extends open enrollment period, launches initiatives to expand health coverage
In an effort to expand health coverage and access, the Centers for Medicare and Medicaid Services is extending regular open enrollment by 30 days, which will now run from November 1 to January 15, 2022, giving consumers more time to review and choose h…
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…
