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Humana loses Medicare Advantage stars lawsuit for a second time
A federal judge ruled in favor of the CMS on Tuesday, one day before the start of Medicare open enrollment. A spokesperson for Humana said the insurer is considering “all available legal options.”
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Sponsored by Express Healthcare StaffingBeyond the resume: Why cultural fit matters in healthcare organizations
Why cultural fit matters as much as credentials in healthcare staffing.
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California passes laws targeting PBMs, private equity
Gov. Gavin Newsom signed an array of healthcare bills into law last week that crack down on pharmacy benefit managers and beef up the review process for deals involving private equity firms.
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Courtesy of CVS Health
CVS closes deal for 63 Rite Aid stores
The drugstore retailer will also bring on more than 3,500 employees from the rival chain and make “targeted investments” in its own stores.
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Healthcare AI investment focused on profit margins, ROI: report
As providers and payers navigate an increasingly challenging financial environment, executives are targeting AI tools that show a clear return on investment, according to a report by Klas Research and Bain & Company.
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Senate Finance Committee probes Medicaid contractors over faulty systems
Top Democrats are airing related concerns that the IT chassis underpinning states’ Medicaid operations may not be robust enough to withstand the added pressure from looming work requirements.
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31,000 Kaiser Permanente workers begin strike in Northern California, Hawaii
The union that represents the workers says the five-day strike is the largest in its history.
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CommonSpirit names new CFO
Michael Browning will step into the position Jan. 2. He replaces Daniel Morissette, who is retiring at the end of this month.
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Trump administration moves to fire HHS employees amid shutdown
Upwards of 1,000 HHS employees were affected. However, the department has rolled back some of the layoffs at the CDC, where the brunt of the terminations were concentrated.
Updated Oct. 14, 2025 -
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Top Democrat questions Medicare Advantage insurers on AI claims denials
The letter from Sen. Richard Blumenthal comes one year after a Senate investigation criticized major MA payers for using predictive technology to deny post-acute care.
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Winners and losers from 2026 Medicare Advantage star ratings
The CMS quietly released anticipated star ratings data Thursday night. Humana and Aetna saw enrollment in highly rated plans fall, while Elevance’s and Centene’s stars improved and UnitedHealthcare’s stayed stable.
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California is the latest state to enact tougher restrictions on private equity in healthcare
The new law prohibits financial firms from having a hand in medical decisions, including determining how many patients clinicians see per hour or what diagnostic tests are appropriate.
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Courtesy of Amazon
Amazon Pharmacy to launch prescription kiosks at One Medical clinics
The kiosks will dispense common medications like blood pressure drugs or inhalers at five Los Angeles area clinics starting in December. Amazon will begin expanding them to other locations next year.
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Pharmacy groups defend Iowa PBM law amid legal challenge
The state passed the law in June in a bid to protect independent pharmacies from certain harmful pharmacy benefit manager practices, but it was quickly tied up in litigation.
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Unnecessary back surgeries cost Medicare $1.9B: Lown
More than 200,000 “low-value” back surgeries for older adults were billed to Medicare from 2020 to 2023 — totaling one unnecessary procedure every eight minutes, according to a new analysis from the Lown Institute.
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Highmark Health names Karen Hanlon president
Hanlon, who has been with the company since 1997, will also continue on as Highmark Health's COO.
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Influential PBM lobby appoints top Express Scripts executive as board chair
Adam Kautzner will oversee the PCMA’s strategy as chair of the board, including its defense of pharmacy benefit managers amid growing scrutiny of their role in rising drug costs.
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UnitedHealthcare swipes at Johns Hopkins, Capital Women’s Care in contract brawl
The insurer accused the health systems of putting business interests over patient well-being in recent failed contract negotiations.
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Oz speaks out about shutdown, Medicaid cuts, Medicare Advantage audits and more
Six takeaways from the CMS administrator’s appearance at a D.C. think tank — including why he supports a clean funding bill to reopen the government.
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Digital health funding outpacing last year as huge rounds increase: report
Investment in 2025 has reached $9.9 billion, exceeding the $8.4 billion that was raised through the third quarter last year, according to Rock Health.
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Courtesy of Hospital for Special Surgery
Q&AHospital for Special Surgery’s Ashis Barad says AI must solve real problems
Barad, chief digital and technology officer at HSS, outlined his approach to evaluating AI tools and how the orthopedic hospital uses the technology.
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Saint Peter’s, Atlantic Health scrap merger
CEOs for the systems called the outcome disappointing and did not suggest there would be future plans to merge.
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Supreme Court hears challenge to Colorado’s ban on conversion therapy
The plaintiffs argue that speech in certain healthcare settings ought to be protected by the First Amendment. Critics say that sets a dangerous precedent, where providers can offer debunked or harmful medical advice with impunity.
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Qualtrics to acquire healthcare market research firm Press Ganey for $6.75B
The deal gives the customer experience company access to Press Ganey’s extensive healthcare data to bolster artificial intelligence capabilities.
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No Surprises dispute resolution remains operational despite shutdown
However, a prolonged lapse in funding could affect other activities underpinning implementation of the law that holds consumers blameless for unexpected out-of-network bills.
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Top healthcare conferences to attend in 2026
These are the events healthcare leaders should plan for next year, covering topics like digital health, rural care and financial management.
