Month: August 2026
A quiet change in California law in 2018 unleashed a deluge of new hospices and spurred millions of dollars in Medicare fraud that state and federal authorities are still trying to unwind. Hospices shared addresses with burrito stands, car repair shops and vacant lots. They piled into nondescript office buildings offering cheap rent, month-to-month leases ...
California’s Medicaid program, Medi-Cal, is slashing asset limits 84% in July 2027. As a result, Medi-Cal members risk losing eligibility — and insurers are feeling the pressure. In 2022, California lifted the asset limit from $2,000 to $130,000 for individuals. CMS eventually approved a state proposal to drop the asset test, but California resurfaced the limits at the beginning of 2026. The 2027 ...
Thomas Zordani flew from his home in Denver to Phoenix for a consultation with a Mayo Clinic neurosurgeon, hoping to find out what could be done to treat his debilitating headaches after worrisome brain scan findings. When making the appointment, Zordani said, he’d been told the clinic was in his insurer’s network. Upon arrival, Zordani ...
A federal appeals court on Tuesday struck down a formula used by healthcare providers, insurers and the government that is designed to shield patients from staggeringly high “surprise” medical bills. In an unsigned decision, a majority of the 17-judge 5th U.S. Circuit Court of Appeals in New Orleans assured the ruling would not lead to ...
A health care advocacy group on Thursday sued the American Medical Association in an effort to get more transparency over the association’s billing codes, which guide billions of dollars in health care payments. PatientRightsAdvocate.org hopes to republish the codes online and allow the public to search them free. The group, which has pushed for health care ...
SCAN Health Plan and Costco will roll out insurance products for older adults in the coming years, according to an Aug. 18 news release. The Wall Street Journal reported that the companies would begin by selling jointly branded Medicare Advantage products in two states, as well as a Medicare supplement in a third state. While the geography was ...
The Pharmaceutical Care Management Association announced Thursday that its members had reached an agreement with the feds to offer information on cash prices available through TrumpRx. The commitment encompasses nine of the industry’s leading pharmacy benefit managers, including the “Big Three” in CVS’ Caremark, UnitedHealth Group’s Optum Rx and Cigna’s Express Scripts. Other participants that have signed ...
When Adam Zolot was ready to expand his paddleboard business into a warehouse-size space on San Francisco Bay, he wedged in one feature that was mostly just for himself: a sauna and cold plunge. An avid longtime traveler, Zolot had picked up his interest in saunas overseas – in the thermal springs of the Aeolian ...
“This story was originally published by CalMatters. Sign up for their newsletters.” Two years ago, California hit a milestone decades in the making: Nearly every person in the state qualified for health insurance, regardless of immigration status and income, pushing the state’s insured rate to a record 95%. Now that progress is unravelling. Facing budget ...
Employer health plans that pay out-of-network doctors or hospitals less than the providers billed now have to tell the providers exactly what plan is paying the bill. A plan that “downcodes” a claim must also give the provider some information about why it downcoded the claim. The new claim payment message requirements took effect last ...