CMS Administrator Seema Verma has stated in a letter to health plan sponsors that CMS will no longer tolerate Medicare Part D gag clauses as the federal agency continues to promote prescription drug...
The latest string of commercial and public payer healthcare fraud cases totaled $21.6 million from providers launching various schemes such as patient kickback agreements and false claims...
Healthcare payers and associated trade groups have expressed enthusiasm about President Trump’s proposed prescription drug pricing reforms.
A number of influential organizations have...
The Medicare Advantage (MA) bidding process requires more competition to increase the availability of high quality MA plans for beneficiaries and reduce federal spending, according to a new Brookings...
The implementation of the Affordable Care Act risk adjustment program has created a number of challenges - as well as some promising opportunities - for payers participating in the ACA marketplaces....
CMS has issued an interim final rule that raises Medicare payments for durable medical equipment (DME) to ensure Medicare beneficiaries have access to critical medical devices.
The rule will raise DME...
CMS Administrator Seema Verma has approved New Hampshire's request to implement Medicaid work requirements and change additional Medicaid rules related to member eligibility. The approval...
Changes to patient care and payment design are required to further the progress of value-based care reforms within the healthcare industry, said CMS Administrator Seema Verma in a speech to the...
A former CMS employee leaked high-level information related to the agency’s rulemaking decisions and changes in provider reimbursement as part of an insider trading scheme, according to a guilty...
The uninsured rate of working adults ages 19 to 64 rose by more than 3 percent between 2016 and 2018, according to the Commonwealth Fund’s ACA Tracking Survey.
In 2016, 12.2 percent of working...
CMS has proposed to implement value-based payment reforms for skilled nursing facilities (SNFs) and other Medicare inpatient facilities in order to reduce fraud and create higher quality healthcare...
CMS has planned to release Medicare Advantage encounter data so that researchers and consumers have the ability to make informed opinions about the cost and healthcare outcomes of the MA program.
The...
Short-term health plans generally lack mental health and prescription drug benefits and may create financial-based health insurance barriers for unhealthy beneficiary populations, according to a Kaiser...
A proposed rule that requires hospitals to post their standard service rates online is only the start of CMS efforts to advance consumer price transparency across the entire agency, according to CMS...
CMS has proposed a new federal rule that increases overall Medicare hospital payments while removing 19 quality measures in efforts to lower administrative burden to Medicare providers. The rule would...
AHIP has issued a statement to CMS that calls for changes in the agency’s proposed rule on association health plan (AHP) and short-term plan policy to avoid unintentional disparities in health...
CMS has received over 1,000 comments from healthcare payers and expert organizations that suggest the agency’s efforts to implement value-based care reform will require changes to provider...
Senator Jeff Merkley (D-OR), with sponsorship from 11 other Democrats, has introduced a bill to create a Medicare health plan for all ages that would be offered in state and federal health exchanges,...
HHS Secretary Alex Azar has appointed James Parker as Senior Advisor to the Secretary of the Office of Health Reform to address healthcare challenges related to health insurance costs and health plan...
The Department of Justice continues its crackdown on Medicare fraud by settling various criminal cases related to $27.68 million of False Claims Act violations.
Provider settlements remain the primary...
