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. 

How Anthem may win by sitting out healthcare’s merger mania

Four of the five major health insurers in the U.S. are involved in major mergers and acquisitions discussed over the past few months. The lone exception has been Anthem, which may put the company in a stronger position, according to the Wall Street Journal.

April 6, 2018

VA: ‘There is no effort underway to privatize VA’

The U.S. Department of Veterans Affairs (VA) is fighting claims from fired VA Secretary David Shulkin, MD, that the agency is moving toward privatizing veterans’ healthcare, issuing a press release calling such talk “completely false and a red herring designed to distract and avoid honest debate on the real issues."

April 6, 2018
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2nd UPMC radiologist accused of healthcare fraud after illegally prescribing Vicodin to non-patients

A month after initial allegations, the second half of a UPMC radiology duo accused of prescribing illegal painkillers to patients is facing federal charges of healthcare fraud, the Pittsburgh Post-Gazette reported this week.

April 6, 2018
Patient in center of network of physicians.

The 10 largest ACOs

A new report from IQVIA has collected information on the largest accountable care organizations (ACOs) in the country based on the number of participating facilities, along with portions of organizational and professional rosters as well as the largest organizations in four of the ACO models offered by CMS.

April 5, 2018

Democrats in California at odds over push for single-payer

In Democrat-dominated California, an intraparty fight is brewing over how to remake the state’s healthcare system. In one corner, advocates are trying to achieve universal healthcare by expanding the Affordable Care Act’s gains in insurance coverage. In the other, there are diehard supporters of moving to a single-payer system.

April 4, 2018

ACR, SBI publish new breast cancer screening guidelines

The American College of Radiology (ACR) and Society of Breast Imaging (SBI) have published new breast cancer screening guidelines, once again recommending that all women begin annual screening at age 40.

April 4, 2018

CMS: 11.8M enrolled on ACA exchanges but ‘more affordable options are needed’

In its final report on the 2018 open enrollment period on the Affordable Care Act (AC) exchanges, CMS said 11.8 million people selected or were re-enrolled in a plan. While the final tally combining enrollment from the federal and state exchanges represents a 3 percent decline from the prior year, supporters of the ACA painted it as a positive, considering cuts in outreach and advertising and the push to repeal the law by the Trump administration.

April 4, 2018
Joshua Gottlieb, PhD

High cost of billing complexity: Up to $54B in physician office revenue challenged every year

Every year, physician offices may deal with as much as $54 billion in revenue being challenged by insurers, with fee-for-service (FFS) Medicaid being “the most challenging type” of payer to bill, according to a study published in Health Affairs.

April 3, 2018