Dane Street is now certified as a federal independent dispute resolution entity, CMS said in a Jan. 26 email. The No Surprises Act intends to prevent surprise billing through its IDR process, which is designed to settle payment disputes between…
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Republican Gov. Greg Abbott is pressing the Texas HHS Office of the Inspector General and HHS Commission to investigate the state’s Medicaid program for fraud, according to a Jan. 16 letter. The push comes weeks after the federal HHS froze…
Angle Health Co-founder and CEO Ty Wang thinks recent CMS and FDA initiatives will set a precedent that goes beyond Medicare. The “Advancing Chronic Care with Effective, Scalable Solutions Model” from CMS and “Technology-Enabled Meaningful Patient Outcomes for Digital Health…
CareFirst BlueCross BlueShield is suing CMS over its 2026 Medicare Advantage star ratings, alleging improper calculations cost the insurer an estimated $32 million in quality bonus payments. The lawsuit, filed Jan. 20 in the U.S. District Court for the District…
A handful of states have declared emergency measures ahead of a winter storm slated to begin around Jan. 24. BCBS North Carolina is explicitly allowing early prescription refills, while Tricare — the U.S. Department of Defense’s health insurance program for…
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The CEOs of the nation’s largest health insurers drew the ire of lawmakers on both sides of the aisle during congressional hearings that went for more than nine hours Jan. 22 over industry consolidation, prior authorization practices and executive pay,…
The House Judiciary Committee in an interim staff report accuses CVS Health of restricting independent pharmacies from working with digital pharmacy competitors to protect its market position. The report, issued Jan. 21 and titled “When CVS Writes the Rules: How…
CVS Health reported progress on key affordability and access initiatives, including reduced prior authorization burdens and expanded biosimilar adoption. The company has about half as many medical services subject to prior authorization as its nearest competitor, according to a Jan.…
UnitedHealth Group’s Optum Rx is monitoring three notable drug candidates that might be approved in the next few months, according to its winter 2026 report published Jan. 2. Two of the medications Optum Rx is tracking are also on GoodRx’s…
Maryland is losing its longstanding rate-setting power for Medicare fee-for-service under CMS’ “achieving healthcare efficiency through accountable design” payment model. Commercial insurers are going to bear the brunt, needing to tackle about half of the state’s necessary savings and covering…