Dec 23, 2024 · The Centers for Medicare & Medicaid Services (CMS) has released the calendar year (CY) 2025 Revisions to Payment Policies under the Physician Fee Schedule (MPFS) and Other Revisions to Medicare Part B Final Rule, which includes proposals related to Medicare physician payments and the Quality Payment Program (QPP). Under the Final Rule, average payment rates under the PFS will be reduced by 2. ...

Dec 17, 2024 · Blue Cross Blue Shield (BCBS) – with 33 of its member companies – recently reached a proposed settlement, agreeing to pay $2.8 billion to settle allegations that BCBS plans violated antitrust laws by suppressing competition and underpaying providers for reimbursements from July 2008 to October 2024.This class action proposed settlement represents the largest antitrust payout to be awarded ...

Jan 8, 2025 · 2025 will be a busy year for healthcare. Here is a list of healthcare conferences and links to registration. Special thanks to Peter Grant and Global Healthcare LLC (GHC) for providing the initial list. Digital Health Summit @ CES 2025January 7-10,

Nov 11, 2024 · Oak Street Health, a wholly-owned subsidiary of CVS Health since 2023, has agreed to pay $60 million to resolve allegations that it violated the False Claims Act (FCA) by paying kickbacks to third party insurance agents in exchange for their recruiting of seniors to Oak Street Health’s primary care clinics.. The United States alleged that prior to CVS’ ownership, in 2020, Oak Street Health ...

Oct 18, 2024 · Humana recently reached a $90 million settlement with the United States to resolve allegations that Humana submitted fraudulent bids to the Centers for Medicare and Medicaid Services (CMS) for Medicare Part D prescription drug contracts from 2011 to 2017. Humana allegedly misrepresented the true costs of its administration of Part D Medicare benefits to obtain more lucrative contracts from the ...

Sep 24, 2024 · The United States Centers for Medicare and Medicaid Services (CMS) recently issued changes to the ACO REACH Model, including adjusting the financial methodology and strengthening the operational flexibility and risk management. Some of the announced changes are below. Benchmarks. One such change relates to the benchmark blend of historical/regional expenditures for standard ACOs.

Jan 27, 2025 · Legal, Regulatory, and Compliance Issues. Pfizer’s subsidiary Biohaven has agreed to a settlement nearing $60 million to resolve allegations of false claims related to…

Jan 2, 2025 · The Academy of Managed Care Pharmacy (AMCP) recently released its second annual report, Access, Affordability and Outcomes: The…

Jan 5, 2025 · Welcome to another edition of our weekly roundup, where we dive into the most pressing legal, regulatory, and policy updates that are shaping the healthcare and medicine landscape. This information is also available on our podcast on Spotify.Here a

Oct 26, 2021 · One of the final healthcare actions made by the Trump Administration has been rescinded by the Biden Administration. On December 23, 2020, the Trump Administration finalized a rule that directed the Department of Health and Human Services (HHS) to take action to require that federally qualified health centers (FQHCs) make insulin and injectable epinephrine available to certain patients at 340B ...