Healthcare It News

MARCH 30, 2022

Department of Health and Human Services Office of Inspector General released a study examining how Medicare beneficiaries used telehealth during the first year of the COVID-19 pandemic. "Telehealth was critical for providing services to Medicare beneficiaries during the first year of the pandemic," read the report.

Medicare 284

Medicare Medicare US Department of Health and Human Services COVID-19 284

Healthcare Dive

JULY 10, 2024

The sweeping payment rule also solidifies continuous eligibility requirements for children in Medicaid and CHIP, and holds hospitals to higher obstetric care delivery standards in a bid to improve maternal mortality.

Hospitals 288

Hospitals Medicare Medicare Medicaid 288

Healthcare IT News - Telehealth

FEBRUARY 22, 2024

Brightside Health will be entering into new and expanded payer partnerships to support telemental healthcare access through Medicare and Medicaid, teaming with companies such as Blue Shield of California, CareOregon and Centene.

Medicaid 134

Medicaid Medicaid Medicare Medicare 134

Healthcare Dive

AUGUST 23, 2023

Three Floridians, including two children, filed a lawsuit against the state on Tuesday alleging it illegally cut their Medicare coverage without proper notice.

Medicaid 246

Medicaid Medicaid Medicare Medicare 246

Healthcare Dive

SEPTEMBER 11, 2024

Though CVS Caremark holds a dominant share of the commercial, Medicare Part D and Medicaid managed care markets, each large pharmacy benefit manager seems to be focusing on one particular arena.

Medicaid 317

Medicaid Medicaid Medicare Medicare 317

Fierce Healthcare

SEPTEMBER 27, 2024

Many counties do not have medication for opioid use disorder (MOUD) services available through providers and treatment programs, and even in counties that do, Medicare and Medicaid beneficiaries of | A new report from HHS OIG looked at access to medication for opioid use disorder services and found many high need counties do not have specialized providers. (..)

Medicaid 129

Medicaid Medicaid Medicare Medicare 129

Healthcare Dive

SEPTEMBER 16, 2024

The Illinois-based pharmacy giant has agreed to pay almost $107 million to settle claims it billed Medicare, Medicaid and other government programs for prescriptions that were never dispensed.

Medicaid 306

Medicaid Medicaid Medicare Medicare 306

Healthcare Dive

APRIL 19, 2023

The payer said it was pleased with the recent CMS decision to phase in risk adjustment changes to the Medicare Advantage program that would allow it to “smooth the impact” to beneficiaries and providers.

Medicaid 246

Medicaid Medicaid Medicare Medicare 246

Healthcare Dive

SEPTEMBER 29, 2023

The Congressional Budget Office report estimated the Center for Medicare and Medicaid Innovation, which was created in part to reduce spending, will increase net federal spending by $1.3 billion from 2021 through 2030.

Medicaid 312

Medicaid Medicaid Medicare Medicare 312

Healthcare Dive

DECEMBER 15, 2022

Together the two will serve nearly 800,000 Medicaid and Medicare members across five states, giving them greater scale to take on competitors.

Medicaid 299

Medicaid Medicaid Medicare Medicare 299

Healthcare IT News - Telehealth

JANUARY 11, 2023

The Kaiser Family Foundation recently looked at state trends with regard to expanding access to telehealth-based behavioral care during the pandemic and found that states see telemedicine as a key component of maintaining access to behavioral healthcare for Medicaid enrollees. WHY IT MATTERS. ON THE RECORD.

Medicaid 163

Medicaid Medicaid Medicare Medicare 163

Fierce Healthcare

AUGUST 15, 2024

The Centers for Medicare & Medicaid Services offered the first look at the potential savings generated by the first crop of Medicare drug price negotiations. | The Centers for Medicare & Medicaid Services offered the first look at the potential savings generated by the first crop of Medicare drug price negotiations.

Medicare 135

Medicare Medicare Medicaid Medicaid 135

Healthcare Dive

NOVEMBER 8, 2023

Medicare Advantage stars, Medicaid redeterminations, individual exchange growth and GLP-1s. Many payers beat Wall Street expectations in the quarter, despite ongoing utilization concerns. Other hot topics?

Health Insurance 276

Health Insurance Medicaid Medicaid Medicare 276

Fierce Healthcare

APRIL 1, 2024

Insurers will feel resentful Monday as the feds opted to not reverse its decision to decrease Medicare Advantage benchmark payments by 0.16%, the Centers for Medicare and Medicaid announced. | CMS is not deviating from its January proposal to modestly rein in Medicare Advantage.

Medicare 143

Medicare Medicare Medicaid Medicaid 143

Fierce Healthcare

APRIL 22, 2024

The Centers for Medicare & Medicaid Services is hoping to improve Medicaid enrollees’ access to care through a final rule that better compensates caregiving roles. | CMS released a series of final rules Monday, including Medicaid access regulations that some groups worry will cause providers to close.

Medicaid 128

Medicaid Medicaid Medicare Medicare 128

Fierce Healthcare

JANUARY 25, 2024

The Centers for Medicare & Medicaid Services is seeking feedback on how to increase transparency around Medicare Advantage and improve data capabilities. |

Medicare 131

Medicare Medicare Medicaid Medicaid 131

Fierce Healthcare

OCTOBER 29, 2024

Accountable care organizations saved Medicare $2.1 billion, the largest yearly savings in program history, in 2023, the Centers for Medicare & Medicaid Services revealed on Tuesday. Accountable care organizations (ACOs) saved Medicare $2.1

Medicare 131

Medicare Medicare Medicaid Medicaid 131

Fierce Healthcare

JUNE 13, 2024

The Centers for Medicare & Medicaid Services (CMS) appears poised to rework Medicare Advantage (MA) quality ratings for this year, The Wall Street Journal

Medicare 128

Medicare Medicare Medicaid Medicaid 128

Fierce Healthcare

NOVEMBER 2, 2024

The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% cut to physician payments in 2025 despite protest from major industry groups. |

Medicare 132

Medicare Medicare Doctors Medicaid 132

Fierce Healthcare

SEPTEMBER 27, 2024

Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the landscape around Medicare Advantage and Part D before si | Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the (..)

Medicare 121

Medicare Medicare Medicaid Medicaid 121

Healthcare It News

APRIL 29, 2024

One way hospitals dealt with staffing shortages and the need for beds during COVID-19 was to use flexibilities allowed by the Centers for Medicare and Medicaid Services to treat acute care patients at

COVID-19 244

COVID-19 Medicaid Medicaid Nurses 244

Fierce Healthcare

OCTOBER 10, 2024

Just 40% of Medicare Advantage prescription drug plans offered in 2025 achieved a score of four stars or higher, the Centers for Medicare & Medicaid Services (CMS) revealed Oct. It's harder than ever for Medicare Advantage plans to score well on star ratings. Here's how they performed for 2025.

Medicare 126

Medicare Medicare Medicaid Medicaid 126

Fierce Healthcare

APRIL 5, 2024

Centers for Medicare & Medicaid Services finalized a host of actions ranging from broker compensation, health equity, mental health, supplemental benefits and biosimiliars, in the Contract Year | Medicare Advantage plans will need to adjust to new star ratings requirements, industry watchers warned following a final rule on Thursday.

Medicare 134

Medicare Medicare Medicaid Medicaid 134

Fierce Healthcare

AUGUST 30, 2023

In a letter sent to all states (PDF), the Centers for Medicare & Medicaid Services ( | As more Medicaid beneficiaries are wrongly kicked off the program, CMS is requiring states to reevaluate its eligibility systems and auto-renewal process.

Medicaid 132

Medicaid Medicaid Medicare Medicare 132

Healthcare Dive

DECEMBER 4, 2023

The HHS’ Office of the Inspector General’s report tallied 707 criminal enforcement actions and 746 civil actions for fraud and misspent funds in programs like Medicare and Medicaid.

Fraud 246

Fraud Governance Medicaid Medicaid 246

Fierce Healthcare

AUGUST 9, 2024

Medicare Advantage and Medicaid woes continued to plague some major payers in the second quarter, with UnitedHealth Group regaining its crown as the most profitable company in the industry for Q2.<

Medicaid 122

Medicaid Medicaid Medicare Medicare 122

Fierce Healthcare

JULY 11, 2024

A recent lawsuit has pushed back against an industry-opposed Centers for Medicare & Medicaid Services (CMS) final rule on broker compensation in Medicare Advantage (MA) plans. | A district court in Texas is halting a federal rule that changes broker compensation and overhauls marketing to seniors.

Medicare 124

Medicare Medicare Medicaid Medicaid 124

Fierce Healthcare

MARCH 27, 2024

The Centers for Medicare & Medicaid Services (CMS) released a final rule Wednesday to help individuals obtain and retain Children's Health Insurance Program (CHIP) coverage. | In a final rule set to take effect in two months, CMS is streamlining its Medicaid and CHIP eligibility, enrollment and renewal processes.

Medicaid 111

Medicaid Medicaid Health Insurance Medicare 111

Fierce Healthcare

SEPTEMBER 6, 2024

In its comments to the Centers for Medicare and Medicaid Services (CMS) on the draft CY2025 Medicare physician fee schedule (PFS), the American Medical Association badgered CMS on its pro | The American Medical Association submitted its comment letter to CMS on its draft CY2025 Medicare physician fee schedule.

Medicare 132

Medicare Medicare Doctors Medicaid 132

Healthcare IT News - Telehealth

JUNE 19, 2023

Over the last few years, Medicare Advantage plans have dramatically increased their deployment of telehealth systems for seniors. While some in the healthcare industry may be skeptical of telehealth’s utilization, particularly within the Medicare population, these plans continue to move full steam ahead.

Medicare 162

Medicare Medicare Telemedicine Medicaid 162

Fierce Healthcare

NOVEMBER 20, 2023

Traditional Medicare paid out an estimated $31.2 The Centers for Medicare & Medicaid Services released its annual look at improper payments and found that the overall rate in Medicare was 7.38%, which sits below the 10% level mandated in statute.

Medicare 131

Medicare Medicare Medicaid Medicaid 131

Fierce Healthcare

NOVEMBER 4, 2024

Days before the 2024 presidential election, the Centers for Medicare & Medicaid Services (CMS) released an unpublished version of the final calendar year 2025 physician fee schedule final rule | Digital therapeutics, telehealth, rural heath clinics and opioid treatment programs all got updates in the final 2025 Medicare physician fee schedule rule, (..)

Medicare 127

Medicare Medicare Medicaid Medicaid 127

Fierce Healthcare

JUNE 4, 2024

SCAN Health Plan secured a court victory Monday when a federal judge agreed that the Centers for Medicare & Medicaid Services (CMS) inappropriately calculated its star ratings for the 2024 plan | SCAN Health Plan secured a court victory Monday when a federal judge agreed that the Centers for Medicare & Medicaid Services inappropriately calculated (..)

Medicare 119

Medicare Medicare Medicaid Medicaid 119

Bill of Health

JUNE 15, 2023

By Laura Dolbow Merck recently filed a lawsuit that challenges the constitutionality of the Medicare price negotiation program created by the Inflation Reduction Act. Merck argues that this form of price regulation charts a “ radical new course ” for Medicare that violates the Takings Clause of the Fifth Amendment.

Medicare 195

Medicare Medicare Medicaid Medicaid 195

Fierce Healthcare

JUNE 1, 2023

The Centers for Medicare and Medicaid Services outlined plans Thursday to broadly cover a new class of Alzheimer’s drugs once the medications get full approval from the Food and Drug Administration | CMS outlined plans Thursday to broadly cover a new class of Alzheimer’s drugs once the medications get full approval from the Food and Drug Administration. (..)

Medicare 145

Medicare Medicare FDA Medicaid 145

Fierce Healthcare

SEPTEMBER 14, 2023

A third set of Medicare Part B prescription drugs will cost up to $618 less per average dose beginning Oct. 1, announced the Centers for Medicare & Medicaid Services (CMS). |

Medicare 130

Medicare Medicare Medicaid Medicaid 130

Healthcare Dive

OCTOBER 1, 2024

Threatened with steep sanctions and loss of its agreement with Medicare and Medicaid, Johnson & Johnson is rolling back a plan to give hospitals after-the-fact rebates for drugs in the 340B drug discount program.

Governance 203

Governance Medicaid Medicaid Medicare 203