Three health systems have filed federal lawsuits against CVS Health, alleging the company and several affiliates improperly diverted about $250 million in savings generated through the 340B drug pricing program. The health systems include New York City-based Mount Sinai Health…
Author: Alan Condon
As a growing number of hospitals and health systems walk away from Medicare Advantage contracts, Cleveland Clinic is moving in the opposite direction, betting that the path forward runs through the payer’s side of the table, not away from it.…
UnitedHealth Group is moving up its share repurchase timeline, announcing plans to deploy at least $2 billion in buybacks by the end of the second quarter. The accelerated timeline is well ahead of its original guidance, which had back-loaded repurchases…
UnitedHealthcare expects to lose 1.3 million Medicare Advantage members and shrink its individual ACA enrollment by roughly one-third in 2026, reflecting a strategic pullback from two major lines of business as the company prioritizes margin recovery over growth, executives said…
OptumServe Health Services, a subsidiary of UnitedHealth Group, has been awarded a contract worth up to $1.61 billion from the Defense Health Agency to provide medical and dental readiness services for military personnel. The contract covers a range of services,…
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Federal regulators are ramping up scrutiny of health system contracting practices, escalating the debate over healthcare costs, competition and market power. The Justice Department recently filed antitrust lawsuits against major health systems, including OhioHealth and NewYork-Presbyterian, alleging they used payer…
Justice Department sues OhioHealth for allegedly blocking lower-cost health plans — 4 things to know
The Justice Department and the state of Ohio on Feb. 20 filed a civil antitrust lawsuit against OhioHealth, alleging the system used anticompetitive contract provisions to drive up healthcare costs for patients and employers in central Ohio. Four things to…
Medicare Advantage now covers about 55% of eligible beneficiaries nationwide — more than 35 million people — but health systems are confronting a question that until recently felt almost taboo: What happens when participation in the country’s fastest-growing Medicare program…
When San Diego-based Scripps Health walked away from nearly all of its commercial Medicare Advantage contracts Jan. 1, 2024, the move drew widespread attention across the industry. Medicare Advantage enrollment was still climbing nationally and many health systems were doubling…
As more hospitals and health systems grow frustrated with Medicare Advantage plans, Ascension is among the organizations rethinking how — and whether — to continue participating. Delays in care, high denial rates and growing administrative burdens are prompting tougher contract…