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Payer Issues

Recession-proofing in heyday of HDHPs | DOJ cracks down on MA plans | 16 execs at top of UnitedHealth | Prisma tech dead, patient charged | Family complaint changes Cigna formula coverage | No transgender policy exclusions, court rules

June 7, 2022 BHR Newsletter Virtual Events  •  Webinars   •   Whitepapers   •   OnDemand Learning  •   Podcasts 1. Justice Department cracking down on fraudulent Medicare Advantage coding, billing Full story 2. Prisma Health employee dead after patient altercation Full story 3. Federal court rules employers cannot deny transgender health…

Medicare hospital fund to run dry in 6 years | BCBS Minn. taps CFO, COO | Tulsa gunman targeted surgeon he blamed for pain | FTC sues to block 2 hospital deals | Payers planned $1B in premium rebates

June 3, 2022 BHR Newsletter Virtual Events  •  Webinars   •   Whitepapers   •   OnDemand Learning  •   Podcasts 1. Medicare hospital trust fund projected to fall short by 2028 Full story 2. Tulsa gunman targeted surgeon he blamed for pain Full story 3. Commercial payers expected to pay $1B this…

7 dead in hospital campus shootings | Insurers shun weight-loss drugs | BCBS exec leaves for startup | U of Iowa Health ups rates 6% | Hospital seeks $6M in damages from Aetna | A new managed care experiment in Calif.

June 2, 2022 BHR Newsletter Virtual Events  •  Webinars   •   Whitepapers   •   OnDemand Learning  •   Podcasts 1. 5 dead in Oklahoma hospital campus shooting Full story 2. 2 dead after shooting at Ohio hospital Full story 3. As some Maine providers drop Anthem, others join Full story 4. Improve…

UnitedHealthcare, WakeMed split | Highmark posts $150M loss | 40 payer exec moves | Kaiser to study shootings like preventable disease | Patients left hanging in BCBS, Springfield Clinic fallout | Feds sue Ga. payer | CareMax to buy Steward's value line

June 1, 2022 BHR Newsletter Virtual Events  •  Webinars   •   Whitepapers   •   OnDemand Learning  •   Podcasts 1. UnitedHealthcare, WakeMed terminate contract Full story 2. Kaiser Permanente to establish gun violence research center Full story 3. Labor Department sues Georgia payer over alleged ERISA violations Full story 4. Is diabetes actually…

Hospital revenues plummet | HHS: No lower Medicare Part B premium in 2022 | Aetna faces class-action suit | Centene sheds office space | U of Vt. Health, UnitedHealth ink contract | Is Maryland's all-payer model replicable?

May 31, 2022 BHR Newsletter Virtual Events  •  Webinars   •   Whitepapers   •   OnDemand Learning  •   Podcasts 1. Hospital revenues plummet Full story 2. Judge greenlights class action against Aetna over alleged disability benefits clawbacks Full story 3. Lower Medicare Part B premium won't come until 2023, HHS chief says Full…

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Providers dropping Anthem | UPMC's big Q1 losses | CVS debuts virtual primary care | Viewpoint: Dominance of MA plans will change everything | CMS zeroes in on hospitals with COVID outbreaks | States are coming for PBMs

May 27, 2022 BHR Newsletter Virtual Events  •  Webinars   •   Whitepapers   •   OnDemand Learning  •   Podcasts 1. UPMC's big losses in Q1: 6 things to know Full story 2. CMS boosts oversight of hospitals with COVID-19 outbreaks Full story 3. State legislatures are coming for PBMs Full story 4. All IT…

Payers broke prior auth promises, AMA says | Dowling: Hospital leaders must stand up against shootings | No Surprises Act halted 2M bills | Feds want PBM crackdown | Patient complaint changes BCBS coverage | UnitedHealthcare's $13.6M denied care payout

May 25, 2022 BHR Newsletter Virtual Events  •  Webinars   •   Whitepapers   •   OnDemand Learning  •   Podcasts 1. Michael Dowling: 'Every single US hospital leader should be screaming about what an abomination this is' Full story 2. No Surprises Act prevented more than 2M unexpected bills, study…

Walmart's 18 preferred providers | UnitedHealth embracing telehealth | Cigna accused of improper claim denials | Hospitals want spotlight on payers' record profits | Opinion: Payers need behavioral 'nudge units' | Empire BCBS opens new HQ

May 24, 2022 BHR Newsletter Virtual Events  •  Webinars   •   Whitepapers   •   OnDemand Learning  •   Podcasts 1. Massachusetts hospitals to spotlight payers' record pandemic profits Full story 2. Former Georgia insurance commissioner indicted on fraud conspiracy charge Full story 3. The 18 health systems Walmart sends its employees…

Cleveland Clinic CFO exits for top payer job | Hospitals want DOJ probe of payer denials | Mayo's $142M operating gain | Health plan data breach affects 120K | Texas city gives insurance to all | Md. caps insulin costs | 8 contract disputes, resolutions

May 20, 2022 BHR Newsletter Virtual Events  •  Webinars   •   Whitepapers   •   OnDemand Learning  •   Podcasts 1. Medical Mutual taps Cleveland Clinic CFO as new CEO Full story 2. Hospitals urge Justice Department to probe insurers over routine denials Full story 3. Rhode Island state hospital at risk…

Tenet hospital's Medicare funding at risk | 3 letters behind single-payer defeat in Calif. | Private payers pay 224% more than Medicare | ChristianaCare to open Highmark-exclusive clinics | Anthem, SCL fight over rate boost | New Medicare website unveiled

May 19, 2022 BHR Newsletter Virtual Events  •  Webinars   •   Whitepapers   •   OnDemand Learning  •   Podcasts 1. Tenet Detroit hospital at risk of losing Medicare contract Full story 2. Commercial insurers paid hospitals 224% more than what Medicare did, study finds Full story 3. CMS launches more user-friendly…

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