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Insurance giant Anthem has announced it will acquire Florida Medicare Advantage plan HealthSun, which could add 40,000 members from the Miami metropolitan area to Anthem’s affiliated Medicare and Medicaid plans in the state.

The comment period for the proposed Medicare Physician Fee Schedule (PFS) has closed, with policy and payment updates drawing a typically mixed reaction from stakeholders within the industry.

One-sixth (17 percent) of physician practices responding to a Medical Group Management Association (MGMA) poll said they’re paying fees from 2 to 5 percent for receiving payments electronically—a practice the MGMA wants CMS to prohibit.

UnitedHealth Group, the largest health insurer in the U.S., is considering acquiring Banmedica, an insurer based in Chile, for an undisclosed amount.

The University of Pittsburgh Medical Center (UPMC) saw its credit rating downgraded by Moody’s Investor Service, along with maintaining a negative outlook on the system, citing its “accelerated expansion and high execution risk” with the acquisition of the seven-hospital PinnacleHealth System.


Recent Headlines

Merger to create $3.8 billion Michigan healthcare organization moves forward

The three individual boards of Southeast Michigan’s Beaumont Health System, Botsford Health Care and Oakwood Healthcare unanimously approved a merger plan and the three healthcare systems’ leaders signed the definitive merger agreement this week.

Texas health system hits nerve by raising entry-level compensation with money from executive bonuses

When Dallas-based Parkland Health & Hospital System announced last week that it would bump up its entry-level pay to $10.25 per hour using the first pool of funds earned by executives as part of a new pay for performance plan, it tapped into a much larger national debate about executive pay, minimum wage levels and income disparity.

Surgery Partners to acquire Symbion in a $792 million deal that will create one of the nation’s largest ASC operators

The already rapidly changing ambulatory surgery center (ASC) market is getting hotter as Surgery Center Holdings Inc. (which does business as Surgery Partners) will acquire Symbion Holdings Corporation and create a company with roughly 100 healthcare facilities and complementary ancillary services in 27 states that combined treat more than half a million patients a year.

DOJ joins whistleblower suit against national hospitalist company

What makes the suit particularly notable is that it involves alleged upcoding of evaluation and management (E/M) claims, a practice that normally does not generate payment differences large enough to justify the time and effort of the Centers for Medicare and Medicaid Services (CMS) conducting audits on such claims.

Castlight finds wide variation in commodity-type medical services

While the complexity of medicine may never fully allow pure commodity economics in healthcare services, certain services, such as diagnostic imaging and laboratory tests, do lend themselves toward being shopped for as commodities. In theory, this should make such services more sensitive to price pressure. But that is not what San Francisco healthcare technology firm Castlight Health found when it examined four such services: low-back MRI, head CT, lipid panel and preventive primary care visit.

Hospital mergers and profits come under fire in Massachusetts

Massachusetts, the first state to enact a universal health insurance coverage law, may also be among the first to experience the political upheaval that could come with healthcare reform driven changes.

ValleyCare community hospitals to become Stanford affiliates

Academic giant Stanford Medical Center in Stanford, California, and ValleyCare Health System, based in Pleasanton, California, have signed a non-binding letter of intent that would make ValleyCare’s two community hospitals and outpatient facilities part of Stanford Hospital & Clinics.

King’s Daughters Medical Center settles with DOJ for nearly $41 Million

After three years of defending the Ashland, Kentucky, hospital against the government’s allegations that it had submitted Medicare and Kentucky Medicaid claims for medically unnecessary cardiology procedures and paid cardiologists kickbacks to perform more procedures at King’s Daughters Medical Center, the hospital negotiated a $40.9 million settlement — roughly double the amount of the alleged false claims.

Amsurg acquires Sheridan Healthcare in transaction valued at $2.35 Billion

Ambulatory surgery center operator Amsurg Corp., Nashville, Tennessee, is making a big play to expand into the fast-growing physician outsourcing market with its purchase of Sheridan Healthcare based in Sunrise, Florida.

PwC finds hospital and physician practice deals down in Q1

In its quarterly analysis of healthcare merger and acquisition activity, PricewaterhouseCoopers LLP, concludes that compared to the first quarter of last year, 2014 so far is fairly soft in announced deals for hospitals and physician practices even thought the incentives to merge are still strong.