Mass General Brigham health plan drops MA coverage for Dana-Farber patients

The Latest

• 

  HaloMD says No Surprises is lowering spending on emergency care. Researchers aren’t convinced.

  The NSA has saved at least $1 billion on out-of-network emergency medical spending, according to the billings firm’s new study. But HaloMD’s methodology leaves something to be desired, independent experts said.

  Payer

• 

  Sponsored by Cedar Gate Technologies, an IQVIA business

  From fragmented healthcare data to intelligent action in the age of AI

  A strong data foundation is the key to scalable healthcare AI.

  Health IT

• 

  Medicare spent hundreds of millions of dollars on ineligible drugs, audit finds

  Shoddy CMS oversight is to blame, and the agency needs to do better, the HHS Office of the Inspector General said. The CMS concurred.

  Payer

• 

  UnitedHealthcare cuts prior authorization from 1,700 codes

  The list tells providers what treatments will no longer need preapproval this October, part of UnitedHealthcare’s pledge to cull 30% of its much-maligned utilization management controls. The codes span a broad range of services.

  Payer

• 

  DaVita agrees to pay $15M to settle claims from data breach

  The dialysis provider has opted to settle a proposed class action lawsuit stemming from a data breach last year that impacted 2.7 million people.

  Health IT

• 

  Johns Hopkins Health Plans taps interim CEO as it searches for successor

  Daniel Chojnowski, JHHP’s current CFO, will provide stability so that the Baltimore-area insurer can recruit full-time for its next chief executive, the company said.

  Hospitals

• 

  Sanford-North Memorial deal closes after systems ink oversight agreement

  The systems agreed to 10 years of state oversight and $600 million in investments as South Dakota-based Sanford moves into the Twin Cities.

  Hospitals

• 

  McKesson confirms data theft in cyberattack involving third-party apps

  The healthcare distributor said the incident affected a subset of customers in its oncology and medical-surgical businesses.

  Health IT

• 

  Mid-cap biotechs join Trump’s latest round of drug pricing deals

  Focused on Medicaid, the new pacts now involve more than just large pharmaceutical companies.

  Government

• 

  Medicaid losses leave more patients paying cash, Epic finds

  An analysis of more than 550 million healthcare encounters from the EHR giant’s research division illuminates how restricting Medicaid coverage leaves low-income patients more directly on the hook for medical bills.

  Hospitals

• 

  Teladoc nabs insurance veteran as new CFO

  Michael Grasher is joining Teladoc effective immediately, filling a finance leadership vacuum left after Mala Murthy departed in November.

  Health IT

• 

  Centene taps Fannie Mae executive as CIO

  Bradley Bolivar is taking the reins of Centene’s IT strategy as artificial intelligence drives a sea change for how insurers do business.

  Payer

• 

  Florida attorney general sues PBMs Express Scripts, Prime over alleged price fixing

  A deal between rival drug middlemen Prime Therapeutics and Express Scripts depressed reimbursement rates for pharmacies, according to the new complaint. It’s the latest legal challenge against the partnership.

  Payer

• 

  Specialty providers refute hefty Georgetown estimates of No Surprises costs

  Researchers estimate that independent dispute resolution has created $22 billion in unnecessary spending. But that estimate is flawed, argue associations representing anesthesiologists, radiologists and ER doctors.

  Payer

• 

  Boston Scientific says cyberattack has disrupted product manufacturing

  The attack has affected the company’s ability to manufacture products and to process and ship customers’ orders. There’s still no timeline for restoration.

  Health IT

• 

  Humana-owned Villages Health agrees to $542M settlement for overbilling Medicare

  The Central Florida provider manufactured fake diagnosis codes for its Medicare Advantage patients from 2020 to 2024, the DOJ said. Humana bought The Villages Health last year.

  Payer

• 

  Physicians want compensation boost from AI productivity gains: survey

  More than 65% of physicians use AI daily or weekly for clinical or administrative work — and some believe they should be paid more if the tech increases their efficiency, according to a Doximity report.

  Hospitals

• 

  Most Americans want providers to disclose AI use, report says

  Nearly half of adults don’t know whether AI has been used in their care, even as hospitals and doctors rapidly adopt the technology, according to a new survey from the Pew Research Center.

  Health IT

• 

  Employers face ‘existential reckoning’ as health costs surge

  Employers are expecting a median 9.2% increase in medical spending next year, according to a new survey. But they’ve underestimated actual cost growth for the past three years, so even that figure may be too optimistic.

  Payer

• 

  Boston Scientific’s ordering, shipping disrupted in cyberattack

  The attack affected global operations, and its full scope is still being determined, the medical device maker said in a securities filing.

  Health IT

• 

  Sword Health to acquire Headspace

  The all-cash deal is expected to close next month, after which Headspace’s wellness services will live under the same roof as Sword's virtual care platform, according to a filing with Massachusetts regulators.

  Health IT

• 

  No Surprises dispute resolution has generated $22B in extra costs, research finds

  Accelerating dispute volumes and sky-high award amounts are inflating how much independent dispute resolution is costing the U.S., according to new Georgetown research. Patients could pay the price with higher premiums.

  Payer

• 

  Monogram Health to pay $2.4M to settle Medicare Advantage upcoding allegations

  Monogram, a home health company, overcharged Medicare through contracts with Cigna and Humana by inflating diagnostic codes, according to the Justice Department.

  Payer

• 

  Suki launches AI dictation tool with EHR integration capabilities

  Suki says its dictation tool, which can be integrated into Epic and Meditech, offers a highly accurate transcription that can be useful for clinicians working with complex medical jargon.

  Health IT

• 

  Elevance’s behavioral health division nabs new president

  Dr. Patrick Fox, a forensic psychiatrist and health plan leader, will take the reins at Carelon Behavioral Services effective immediately. His experience will be “invaluable” for the unit, a top Elevance executive said.

  Payer

• 

  Healthcare costs could rise by nearly 10% in 2027

  Employers plan to cover more than 80% of the burden, but employees will also be hit by rising costs, an Aon report found.

  Payer

More stories