Graham’s Death Creates New Uncertainties For GOP Health Agenda

The sudden death of Sen. Lindsey Graham has removed a longtime opponent of the Affordable Care Act’s major medical insurance provisions from the Senate and changed the gameboard for efforts to pass “Reconciliation 3.0” legislation this year. Graham, 71, died Saturday shortly after returning home from a trip to Ukraine. The cause of death was ...

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HHS Watchdog Expects $5.56B In Recoveries And Savings In Fraud Crackdown

The federal watchdog for the Department of Health and Human Services (HHS) generated $5.56 billion in expected recoveries and projected savings over a six-month period, according to a report issued Monday, and it barred just more than 1,200 individuals and companies from federal programs. The HHS Office of Inspector General (OIG), in a semiannual report to ...

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As GOP Cries Fraud, Newsom Backs Medicaid Spending on Housing and Food

Sen. John Kennedy of Louisiana is taking aim at California’s Medicaid program for providing housing assistance, food, and other social services to high-need, low-income patients who tend to rack up big healthcare costs and, he argued, strain taxpayer funds. The Republican blasted California during back-to-back political attacks in May, saying the heavily Democratic state is ...

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Nearly 5,000 Pharmacies Unite In Federal PBM Price-Fixing Lawsuit

A trade group representing nearly 5,000 independent pharmacies has filed a lawsuit alleging that Prime Therapeutics entered into an anticompetitive agreement with Cigna’s Express Scripts to fix pharmacy reimbursement rates and fees. The complaint was filed last week in federal court in Washington, D.C., by Protecting Access to Retail Pharmacy, which operates under the name ...

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‘The System Is Undeniably Broken’: More Insurers Sue CMS Over Medicare Advantage Stars

More insurers are filing lawsuits in an attempt to hike their Medicare Advantage quality scores after a court decision earlier this year exposed federal regulators to a new line of legal attacks. SCAN Health Plan and Alignment Healthcare both sued the CMS in D.C. district court last week, arguing regulators robbed them of higher star ...

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Insurers Set To Pay Out $759M In 2026 MLR Rebates: KFF

Insurers expect to issue $759.2 million in medical loss ratio rebates this year, according to a new analysis. The report is based on data reported by payers to states and compiled by analytics firm Mark Farrah Associates. An analysis of the data from KFF projects that total rebates paid out since their 2012 launch will rise to ...

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