Category: Healthcare Finance News

Nostrum to pay up to $50 million for allegedly underpaying Medicaid drug rebates

Missouri- and New Jersey-based drugmaker Nostrum Laboratories and its founder and CEO, Dr. Nirmal Mulye, have agreed to pay a minimum of $3,825,000 – and up to $50 million if certain financial contingencies are met – to resolve allegations that they vi…

Private insurers’ prices differ based on region

Prices negotiated by health insurers show a wide amount of variation between geographic locations, with a new study in JAMA Health Forum showing that these price variations often occur with the same insurer, costing more in one locale than in another. 

CMS bumps ESRD facility payments by 2.1%

In a final rule, the Centers for Medicare and Medicaid Services is increasing the end-stage renal disease (ESRD) prospective payment system (PPS) base rate to $271.02, increasing total payments to ESRD facilities by about 2.1% in an update to payment r…

CVS, Kaiser Permanente and Mayo Clinic invest in Abridge

CVS Health Ventures, Kaiser Permanente Ventures and Mayo Clinic are among the healthcare organizations investing $30 million in Abridge’s latest funding round.
The Series B funding was led by Spark Capital and also included existing investor Bessemer V…

Information blocking could affect provider payment, MIPS and MSSP participation

Providers face monetary disincentives for violating information blocking, under a proposed rule released today by the Department of Health and Human Services.

Clarity and more timely results proposed for Independent Dispute Resolution process

A proposed rule pertaining to the controversial No Surprises Act Dispute Resolution process, would, if finalized, require payers to provide additional information at the time of initial payment or notice of denial of payment. 
The proposals aim to incr…

HIMSSCast: Getting to value through the right data 

Clinical decision support, such as what is offered by Wolters Kluwer, handles the avalanche of information providers and physicians need to stay informed.
The information services company has a team of over 7,000 physician editors –  specialists in the…

UnitedHealthcare is expanding individual, family plans on the marketplace

UnitedHealthcare has announced it is expanding its Individual and Family Affordable Care Act Marketplace Plans from 11 to 26 states in 2024.
The expansion increases its ACA footprint from 177 to 1,032 counties.

Bipartisan lawmakers tell HHS to reconsider nursing home staffing mandate

Ninety-one bipartisan members of Congress have joined in objecting to a Centers for Medicare and Medicaid Services proposed rule for minimum staffing levels at nursing homes.

Court upholds $2.7 billion Blue Cross antitrust settlement

An 11th Circuit panel in Atlanta has upheld a class action settlement in a $2.7 billion antitrust case against the Blue Cross Blue Shield Association, which means benefits will now be distributed to the subscribers who sued Blue Cross more than a decad…