Policy & Regulations

This channel includes news coverage of healthcare policy and regulations set by Congress, the states, Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services (HHS), U.S. Food and Drug Administration (FDA), and medical associations and societies. 

Medicare FFS amassed $23.2B in improper payments in 2017

Medicare fee-for-service (FFS) programs racked up an estimated $23.2 billion in improper payments in 2017, according to CMS data—almost $19 billion more than Medicaid FFS’ $4.3 billion and a red flag that the program’s documentation requirements might not be up to par.

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Purdue Pharma reaches $270M settlement in opioid case

Purdue Pharma agreed to a $270 million settlement March 26 to help battle Oklahoma’s opioid crisis after a slew of lawsuits threatened to edge the company into bankruptcy.

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‘All-out war’: Trump administration supports ruling to invalidate entirety of Obamacare

The Trump administration filed a notice March 25 supporting a federal judge’s ruling that the Affordable Care Act should be thrown out in its entirety—a sharp pivot from the administration’s previous position that only parts of the law should be eradicated.

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CVS shares down 30% after Aetna merger

CVS Health’s merger with managed care company Aetna has resulted in lower stock shares and some financial stress, but strategies to reduce unnecessary medical expenses and capitalize on trends like cannabis legalization might ease some of that discomfort, CNBC reported March 21.

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Final 2019 open enrollment report: ACA sign-ups dip to 11.4M

CMS issued its final Health Insurance Exchanges 2019 Open Enrollment Report on March 25, touting stabilized premiums and extended “grandmother” policies amid sign-ups that numbered 300,000 fewer than last year.

Amazon accepting HSA, FSA cards for healthcare buys

Amazon is now accepting pre-tax health spending accounts in the form of health savings accounts (HSA) and flexible savings accounts (FSA), providing users with discounts for hundreds of everyday health items ranging from glucometers to fever strips.

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CMS updates drug spending dashboards

CMS has updated its drug spending dashboards with data for 2017, adding information for “thousands” more drugs included in Medicare Parts B and D and Medicaid to its publicly accessible database.

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Hospitals could soon publish negotiated prices

The Trump administration is reportedly considering requiring hospitals and other healthcare providers to publish the prices they charge insurance companies for services after the rates have been negotiated, The Wall Street Journal reported.

Around the web

CMS finalized a significant policy change when it increased the Medicare payments hospitals receive for performing CCTA exams. What, exactly, does the update mean for cardiologists, billing specialists and other hospital employees?

Stryker, a global medtech company based out of Michigan, has kicked off 2025 with a bit of excitement. The company says Inari’s peripheral vascular portfolio is highly complementary to its own neurovascular portfolio.

RBMA President Peter Moffatt discusses declining reimbursement rates, recruiting challenges and the role of artificial intelligence in transforming the industry.