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Independence Blue Cross to pay $22.5M to resolve MA fraud allegations
Independence Blue Cross will pay to settle allegations it defrauded Medicare by inflating diagnosis codes for MA beneficiaries. The payer cited “industry-wide challenges” in applying MA risk adjustment standards.
By Jill Hughes • Oct. 2, 2026 -
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Governors ask HHS for more time to implement Medicaid work requirements
The governors of Oregon, California, Maine, New York and Virginia don’t think it’s possible for states to meet the Jan. 1 deadline to stand up work requirements while protecting beneficiaries.
By Rebecca Pifer Parduhn • Oct. 2, 2026 -
Explore the Trendline➔
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TrendlineSurprise Billing
Federal legislation banning surprise bills has hit a barrage of roadblocks, complicating efforts to protect consumers from unexpected out-of-network charges.
By Healthcare Dive staff -
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HRSA discloses manufacturers approved for revised 340B rebate pilot
Ten pharmaceutical companies will start paying after-the-fact rebates instead of upfront discounts on 21 drugs in 340B at the start of next year, more than in the Trump administration’s first attempt at a rebate program.
By Rebecca Pifer Parduhn • Oct. 1, 2026 -
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Here’s how much insurers are cutting Medicare Advantage plans for 2027
Newly released CMS data shows that insurers continue to adapt to pressure in the privatized Medicare program by culling plans. A press release stressing “stability” didn’t soften the blow.
By Rebecca Pifer Parduhn • Sept. 29, 2026 -
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FDA nominee Overton parries vaccine questions at Senate hearing
Pressed by lawmakers on Thursday, Trump’s pick as the next FDA chief said she’d “follow the law” on key decisions and work to speed early drug research.
By Jonathan Gardner • Sept. 24, 2026 -
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AI will inflate healthcare costs before lowering them, Oz says
AI will “turbocharge” medical billing and drive up costs in the short term, CMS Administrator Dr. Mehmet Oz warned. But he said the pain is worth it for long-term savings.
By Jill Hughes • Sept. 24, 2026 -
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Oz: Medicare Advantage a garden ‘vulnerable to weeds and overgrowth’
The CMS administrator’s comments Tuesday at an MA industry event suggest that the Trump regime remains interested in tougher oversight of the program, despite watering down or scrapping some of its biggest proposed reforms.
By Rebecca Pifer Parduhn • Sept. 23, 2026 -
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CMS freezes new ACA broker registrations for 2027, culls ‘unauthorized’ enrollees
The agency said the pause would help crack down on fraud among new brokers on the exchanges. It also announced on Tuesday it would cancel the enrollments of more than 760,000 people.
By Jill Hughes • Sept. 23, 2026 -
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MedPAC chair defends Medicare Advantage overpayment analysis at insurer lobby event
Amid growing public debate over how best to analyze spending in MA versus traditional Medicare, Dr. Amol Navathe, the leader of the group behind the most-cited estimate, stepped into the lion’s den to support its work.
By Rebecca Pifer Parduhn • Sept. 23, 2026 -
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Trump administration sets preliminary cuts to Medicare lab reimbursement rates
The American Clinical Laboratory Association warned the steep annual payment cuts threaten patient access to critical lab testing services.
By Susan Kelly • Sept. 22, 2026 -
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New lawsuit targets Medicaid work requirements’ medical frailty rules
The new lawsuit, filed on behalf of five Medicaid enrollees and a swath of provider groups, says the CMS narrowed exemptions for those too sick to fulfill upcoming work requirements in the safety-net insurance program.
By Sara Heath • Sept. 22, 2026 -
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Colorado judge: Doctor’s burnout wasn’t a disability
The Americans with Disabilities Act and related federal laws define disability broadly, but recent federal court decisions demonstrate the statute’s limits.
By Ryan Golden • Sept. 21, 2026 -
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A hidden tradeoff in Trump’s MFN drug deals
The government has announced pricing agreements with 26 pharma companies. But the deals could stymie other plans to lower the country’s drug spend.
By Kelly Bilodeau • Sept. 21, 2026 -
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Q&AWhy HaloMD became a target — and what its top lobbyist says critics get wrong
Patrick Velliky is confident the No Surprises Act is lowering out-of-network spending, despite research to the contrary. HaloMD’s chief external affairs officer responds to criticisms of his analysis, and of his company.
By Rebecca Pifer Parduhn • Sept. 17, 2026 -
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Federal watchdog accuses Humana, UnitedHealthcare Medicare Advantage plans of upcoding
Newly released HHS OIG audits of HumanaChoice and UnitedHealthcare of Wisconsin found both plans frequently exaggerated the health needs of their members, generating almost $180 million in overpayments over two years.
By Rebecca Pifer Parduhn • Sept. 17, 2026 -
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CMS to add more chronic conditions to ACCESS model in 2027
The Trump administration is expanding Medicare’s new technology-based payment experiment to cover more chronic conditions, including COPD, substance use disorder and tobacco cessation.
By Anuja Vaidya • Sept. 16, 2026 -
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HHS adds new IDR entity as surprise billing disputes surge
Physio Solutions, which does business as Medlitix, is the 17th company certified to settle out-of-network payment disputes under the No Surprises Act as arbiters face increasing scrutiny from researchers and lawmakers.
By Jacqui LaPointe • Sept. 15, 2026 -
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2.3M young adults could lose Medicaid due to Big Beautiful Bill: study
Actual disenrollment will depend heavily on how easy states make it for young adults, who move frequently and participate in hard-to-track gig work, to prove they should stay enrolled, the Urban Institute found.
By Jill Hughes • Sept. 15, 2026 -
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More than half of hospitals still not fully compliant with price transparency rules: report
A record number of hospitals are fully sharing data on the cost of their services, thanks to the CMS stepping up enforcement. But there’s still a ways to go, according to PatientRightsAdvocate.org.
By Rebecca Pifer Parduhn • Sept. 11, 2026 -
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Half of Medicare Advantage stars thresholds harder to reach in 2027
The CMS has released draft star ratings, including the thresholds for reaching those ratings, to plans. The grading sheet got stricter, which doesn’t bode well for insurers, one MA expert said.
By Rebecca Pifer Parduhn • Sept. 10, 2026 -
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Veterans Affairs taps Amwell for telehealth revamp
It's another prong in the agency's digital health modernization project, which has faced setbacks and delays.
By Anuja Vaidya • Sept. 10, 2026 -
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Top Democrat investigates No Surprises arbiters
Rep. Frank Pallone sent oversight letters to six arbiters requesting information on how they decide awards, how they’re paid and more. His office is also in talks with other arbiters, but they’ve been more responsive, a staffer said.
By Rebecca Pifer Parduhn • Sept. 9, 2026 -
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Cambia, Arkansas Blue Cross affiliation moves ahead
No assets are changing hands as a result of the deal, which is expected to close this October with Cambia assuming control of the Arkansas Blue plan’s operations.
By Rebecca Pifer Parduhn • Sept. 8, 2026 -
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Adena Health acquires Fairfield Medical Center after antitrust scrutiny
Pressured by federal antitrust concerns, Fairfield Medical Center has completed a merger with Adena Health after pivoting from a planned sale to state giant OhioHealth.
By Eric Wicklund • Sept. 4, 2026 -
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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.
By Rebecca Pifer Parduhn • Sept. 2, 2026
