St. Louis-based Ascension has become the third-largest ASC operator after its $3.9 billion acquisition of AmSurg expanded its footprint to more than 300 surgery centers. The health system now trails only Tenet Healthcare’s USPI, which operates more than 535 ASCs…
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A man charged in connection with one of the largest Medicare fraud schemes in U.S. history is back in American custody after being apprehended in Northern Cyprus and flown to South Florida, the Justice Department said June 23. Ibrahim Khaldoon…
The White House Council of Economic Advisers addressed the possibility of banning antisteering practices, which prohibit insurers from guiding patients to lower-cost providers, in payer-provider contracting. Its conclusion: Prices and premiums could drop. Along with broader antisteering issues, the memo…
The Congressional Budget Office is requesting more research on the No Surprises Act. In a June 15 website post, CBO called for research relying on more recent data, as claims data for existing studies end in 2023, while arbitration patterns…
CMS is “voluntarily recalculating” 2027 Medicare Advantage quality bonus payment ratings, based on 2026 star ratings, following Clover Health’s successful challenge of the agency’s measures. CMS sent a letter informing health plans June 17. In its reevaluation, CMS will only…
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ICHRA, reference-based pricing, narrow networks, direct contracting, cash pay — it seems you can’t escape these terms today in the employer health benefits market. Each is traceable back to the same gradual shift happening among the leverage structures that have…
As of fiscal 2023, nearly three-quarters of Medicaid beneficiaries were enrolled in a full-risk managed care organization, up from less than half in fiscal 2010. On June 15, the Medicaid and CHIP Payment and Access Commission, an agency that advises…
Many Blue Cross Blue Shield plans posted operating or underwriting losses in 2025 as medical and pharmacy costs climbed, but investment income lifted several of them to positive net income for the year. Combined profit margins across all BCBS plans sank to…
Commercial health plans are facing the steepest single-year cost increase in 17 years, with the group market trend projected to reach 9% in 2027, according to PwC’s annual medical cost trend report published June 11. PwC surveyed and interviewed actuaries…
MultiPlan, now rebranded as Claritev, has been at the center of multiple sprawling legal challenges regarding its repricing tools. While some battles have been ongoing, others are just gaining steam. MultiPlan, a data analytics firm, offers payers tools to inform…