Author's posts
LRMC pays $4M to DOJ over allegedly impermissible Medicaid donations
Lakeland Regional Medical Center (LRMC) in Lakeland, Florida, has agreed to pay the United States $4 million to resolve allegations that it made donations to a local unit of government to improperly fund the state’s share of Medicaid payments to LRMC.
Insurers had strong year, but weaker earnings are ahead, says Moody’s
Health insurers ended 2022 with earnings up from the year prior, with EBITDA growing 12% in the fourth quarter, though a new report from Moody’s Investors Service predicts that this growth will slow in 2023.
Site-neutral payment policies could save Medicare $471 billion
Adopting site neutral payment policies for Medicare would yield savings for the program, for private insurance premiums and for enrollees’ out-of-pocket costs, which would total about $471 billion over the next decade, according to a new analysis from …
University of Pittsburgh Medical Center, DOJ settle whistleblower suit
Dr. James Luketich, University of Pittsburgh Medical Center and University of Pittsburgh Physicians have settled with the United States government over a whistleblower lawsuit, brought in September 2021, that alleged fraudulent billing and unsafe surgi…
Top Stories: ATA opposes DEA changes to telehealth prescriptions; AHA favors further study of telehealth
It’s been a big week for telehealth. What’s new in the world of virtual care? We’ll go over the latest in this week’s Top Stories, including the AHA’s support of bipartisan telehealth legislation, and results of a telemedicine-focused Rock Health study…
House committee investigating potentially anticompetitive PBM tactics
The House Oversight Committee has launched an investigation into pharmacy benefit managers’ tactics that Chairman James Comer (R-KY) said are “harming patient care and increasing costs for consumers.”
Medicare Advantage margins higher for insurers despite dip
Payers saw their Medicare Advantage margins revert back to pre-pandemic levels in 2021, yet those margins were still double those seen in other markets, according to a new analysis from the Kaiser Family Foundation.
By the end of 2021, gross margins pe…
Clover Health cuts losses, logs $84M loss in Q4
Medicare Advantage insurtech company Clover Health logged an $84 million loss in the fourth quarter of 2022, much less than the $187.2 million loss it sustained during the same quarter in 2021, according to the company’s earnings report.
Hospitals more stable to start the year, but challenges remain
Hospitals entered 2023 on more stable footing, following the worst financial year since the start of the COVID-19 pandemic. However, they still face a range of persistent challenges, including higher labor expenses, lower patient volumes and a fundamen…
Medicare Advantage sees fewer avoidable hospitalizations than original Medicare
Medicare Advantage had fewer avoidable hospitalizations for ambulatory care−sensitive conditions (ACSCs) when compared to traditional Medicare, but were more likely to have observation stays and emergency department direct discharges for the same condi…
