Category: FierceMarkets

In Medicare Advantage market, Cerner straddles the line between partner and competitor

Cerner is digging into what it sees as a lucrative Medicare Advantage market leveraging a recently announced partnership with Lumeris. But Centene’s recent joint venture with Ascension—a Cerner health system—could put the vendor at odds with one of its…

Humana sues dozens of generic drug manufacturers for price-fixing scheme

At conferences, over dinner, via text, and more, the companies colluded to increase the price of drugs for common conditions as much as 8,000%, the insurer’s complaint says.

Teladoc CEO: Medicare telehealth proposal paves the way for long-term expansion

Noting that the Medicare proposal to reimburse physicians came “earlier than we expected,” Teladoc CEO Jason Gorevic says the administration is backing a long-term expansion of telehealth coverage.

Study: Provider consolidation outpaces payer in more than half of metro areas 

Healthcare’s “merger mania” has led to significantly consolidated provider markets, according to a new report, which could have some major downsides for patients. 

Prime Healthcare Services and CEO settle upcoding case for $65M

Prime Healthcare and its CEO agreed to pay $65 million to settle allegations that 14 of its California hospitals admitted patients for inpatient care who actually required less costly outpatient care.

With a stunning Q2 performance, Molina is officially a comeback story

This time last year, Molina Healthcare had just dumped its CEO and CFO and was on its way to $512 million in losses. Now, the company has mounted a comeback, and it’s eyeing the ACA exchanges as its next target.

CMS missed deadline to create MACRA-mandated chiropractic preauthorizations, GAO says

A year and a half after it was supposed to implement a preauthorization process for chiropractic claims, an industry with a 41.7% improper payment rate, CMS still hasn’t established that process.

Cigna CEO throws support behind telehealth as advancing a ‘choice-based model’

Partnering with multiple telemedicine providers gives consumers additional choice, which ties directly into the company’s model, said President and CEO David Cordani.

With merger vote approaching, Cigna and Express Scripts diverge on value-based contracts

Three weeks ahead of the vote on their planned merger, the two companies expressed far different levels of enthusiasm for rewarding value over volume.

Hospitals see a $4.8B lift in final CMS payment rule that focuses price transparency, interoperability

The Centers for Medicare & Medicaid Services (CMS) has finalized a hospital payment rule that includes an additional $4.8 billion for inpatient services as well as several new requirements around price transparency and data sharing.