The Affordable Care Act (ACA) requires fully insured group health plans to spend a minimum percentage of premium dollars on members’ health care expenses and services. Likewise, it sets a threshold on the maximum amount of premium dollars that can be spent on other administrative costs, such as marketing, profits, salaries, agent commissions, etc. These ...

The Biden administration wants to crack down on private arrangements among some hospitals to reimburse themselves for taxes that help fund coverage for low-income people. It contends the practice violates federal law. Federal regulators say these arrangements “appear designed to” redirect Medicaid dollars away from facilities that treat the poorest patients to those that “provide ...

Minutes after Lainey Arebalo gave birth to her third child last September, hospital staff noticed her son was having trouble breathing. They recommended placing the infant in an ambulance so he could receive care at a better-equipped pediatric facility 23 miles away. Within days of receiving that extra care, Avebalo was able to bring her ...

The prices charged for drugs like Ozempic, Wegovy and Mounjaro are significantly higher in the U.S. when compared with other wealthy nations, with the list price being 10 times lower in some countries, according to a new analysis from KFF. As KFF’s analysis found, a one-month supply of Ozempic — which is indicated for diabetes ...

Arlene Wright is a doctor, but she doesn’t want people to call her one. “I usually tell my patients ‘your majesty’ or ‘your highness’ is fine,” she said. Wright has been a nurse for more than 20 years in Fort Myers, Fla. She began working in hospitals as a teenage candy striper in Upstate New ...

Key computer systems at hospitals and clinics in several states have yet to come back online more than two weeks after a cyberattack that forced some emergency room shutdowns and ambulance diversions. Progress is being made “to recover critical systems and restore their integrity,” Prospect Medical Holdings said in a Friday statement. But the company, ...