The agency announced its appeal of a court ruling it lost to Clover Health, which resulted in the agency recalculating the grades it gave to the payer’s Medicare Part C plans. Other insurers are now asking for the same redo, spurring CMS to appeal the initial ruling.

She quit her post in disgust last August after serving a decade in the C-suite of the Centers for Disease Control and Prevention. Now Deb Houry, MD, MPH, is looking out over U.S. healthcare with glass-half-full enthusiasm. 

One major operation is largely camouflaged—in fact it’s effectively out of sight—but it’s a prime mover in the Trump administration’s ongoing crackdown on healthcare fraud. 

When a nursing home closes down, the local population and press often perceive the move as a simple exit from the market due to failing fiscal health. But in about half the cases, additional forces are in play—and “closures” may be, in truth, do-overs of one kind or another. 

The shift in prosecutorial focus is part of a new enforcement policy to address healthcare fraud. The U.S. Department of Justice alleges the CEO of CampusEye paid kickbacks to doctors for referrals, going on to bill Medicare for unnecessary tests.

Was Dr. Anthony Fauci a lighthouse keeper ably guiding America through a dense fog, albeit by contingent directions and course corrections? Or was he a power-mad scientist cynically covering his tracks—heedless of the resulting population-level harms unfolding day by day—after helping start the crisis in the first place? 

With the change, premiums are expected to rise. However, the Centers for Medicare & Medicaid Services confirmed they cannot inflate by more than 6%, as capped by the Inflation Reduction Act. 

A U.S. District Court judge ruled that the states were unable to show they would be irreparably harmed by complying with the policy, as the Centers for Medicare & Medicaid Services is covering 90% of the associated costs.