Editions
The archive
Every American Health Intel issue, newest first. Rules, money, and medicine, decoded daily.
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The Ledger31.5 million dollars: that is what a Sunnyvale startup just raised to build a single procedure that images and treats the prostate, with one of the world's largest device makers as a new backer.
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The RegulatorThree: that is the number of everyday pieces of Medicare paperwork, an enrolled supplier number, a doctor's order, and a beneficiary's ID, that federal investigators say fraudsters have turned into a reliable formula for stealing durable medical equipment money from taxpayers.
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The Regulator$90 million: that is the federal rural health windfall CMS says South Dakota just delivered to 82 hospitals and clinics, out of 144 that applied for triple the money.
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The Ledger1 billion dollars: that is how much debt a dental support organization just erased by handing the keys to the private credit firms that financed its 2021 buyout, wiping out the private equity firm that bought it.
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The RegulatorAugust 24: that is when the Justice Department formally moves health care fraud prosecutions into a division built specifically to chase them, under a final rule it published today.
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The Regulator500: that is how many attorneys and staff the Justice Department's new fraud-fighting division will have on the ground within days, after its chief used his first policy memo to put home health, hospice and telemedicine squarely in the crosshairs.
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The Ledger10 percent: that is the median health care cost increase employers expect to face in 2027, the second year in a row benefits professionals have forecast a double digit jump, with weight loss drugs now the single biggest driver inside that number.
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The Regulator67 percent: that is the share of Medicare Advantage prior-authorization denials that get overturned when patients or doctors actually appeal them, the first insurer-by-insurer numbers a federal rule has ever forced into public view.
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The Regulator208 million dollars: that is the restitution a fugitive Medicare fraudster agreed to repay after fleeing to the Philippines rather than face sentencing for a scheme prosecutors valued at $1.2 billion.
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The Service LineMaineHealth's board confirmed on August 6 what its own numbers argued against, closing a labor and delivery unit that delivers 43 percent more babies than it did in 2019, and five days later a national report showed the closure is the rule, not the exception.
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The Ledger475 million dollars: that is what a Zydus Lifesciences subsidiary could pay for a drug that has not finished a single Phase 3 trial, betting on a rare lung disease with no approved treatment anywhere in the United States.
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The Regulator235 million dollars: that is the ten-year taxpayer savings CMS projects from a rule ending federal Medicaid and CHIP funding for gender-transition procedures in children, released yesterday and headed for the Federal Register tomorrow.
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The Ledger1.32 billion dollars: that is what Jazz Pharmaceuticals is paying to buy a rare epilepsy drug that has never treated a single paying patient, the company's boldest bet yet on a genetic disorder no approved drug touches.
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The Regulator27.7 million dollars: that is how much prosecutors say a Los Angeles hospice operator and his marketer billed Medicare using the stolen identities of dead people, in a trial scheduled to open today.
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The Service LineRadNet, the country's largest publicly traded chain of outpatient imaging centers, posted 25 percent revenue growth in the second quarter of 2026 and just opened a new 250 million dollar credit line earmarked for more acquisitions, the clearest signal yet that the buyer market for independent radiology groups keeps getting more competitive.
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The Ledger51.6 million dollars: that is the operating loss Tufts Medicine posted for the fiscal year that just closed, a dramatic improvement from a 214 million dollar loss the year before, and it is still enough for the health system's board to push out its chief executive and chief financial officer.
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The Regulator230 billion dollars: that is the fraud the White House says it has uncovered across federal programs since January 2025, and health care, not any other single sector, supplied the single biggest piece of the tally.
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The Ledger578 million dollars: that is what CommonSpirit Health lost from operations in a single quarter this year, the financial backdrop against which nurses at one of its Northern California hospitals picketed this week over plans to cut maternity and cancer-infusion staff.
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The Regulator28 patients: that is how many federal reviewers found may not yet have died when Kentucky's organ procurement organization began preparing them for donation, the finding behind only the second time the federal government has ever decertified an organ procurement organization (OPO).
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The Service LineThe Department of Justice just handed down its first-ever decision not to prosecute a health care company under a brand-new corporate leniency policy, and the case centers on an ambulatory surgery center's management company, not a hospital.
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The Ledger81 percent: that is how far Doximity's stock jumped in a single session on a guidance raise built almost entirely on a product that has not booked a dollar of revenue yet.
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The Regulator15.2 million dollars: that is what Medicare improperly paid physicians for sacroiliac joint injections nationwide, after federal auditors found nearly three in four sampled sessions violated program rules, in a report where CMS refused to build the fix that would stop the biggest error going forward.
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The Service LineCMS finalized next year's hospice pay rule this week, and buried inside a routine rate update is the agency's most detailed public fraud-scoring system yet.
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The Ledger1.09 billion dollars: that is the operating income Oscar Health already banked in just the first half of 2026, more than its entire newly raised full-year guidance implies it will keep, meaning the insurer's own numbers point to a swing back to a loss in the second half.
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The Regulator2.1 billion dollars: that is how much more Medicare will pay the nation's hospitals next year, in a rule that also forces nearly every one of them into a single national experiment on hip, knee and ankle replacements.
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The Service LineCMS just published the audit playbook every state will use on the fastest-growing benefit in behavioral health, and the growth curve behind it explains why.
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The Ledger106.1 billion dollars: that is CVS Health's second quarter revenue, beating Wall Street by 6 billion dollars, and the stock still fell more than 6 percent.
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The Regulator5.76 million dollars: that is how much prosecutors say Pennsylvania home-care aides and agencies billed Medicaid for schemes including one aide who kept billing while incarcerated, the debut case for a new Justice Department fraud unit permanently embedded in Philadelphia.
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The Service Line8 billion dollars: the price tag on the largest deal in radiopharmaceutical industry history, and it is a bet that targeted radiation, not chemotherapy, is where cancer treatment margin moves next.
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The Ledger5.7 billion dollars: that is what KKR is paying to take the world's largest pure-play medical device contract manufacturer private, a 52 percent premium and the biggest healthcare buyout of the week.
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The Regulator14.1 million dollars: that is what a Jacksonville health-management company is paying the federal government for pushing doctors to add mental-health and addiction diagnoses that were not true, just to collect bigger Medicare Advantage checks.
- The Service Line
Cardiology's 2027 pay headline reads plus 1 percent. The line items underneath read like a cut.
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The Ledger8 billion dollars: that is the ceiling on a deal announced this morning that would combine two of the world's largest radiopharmaceutical makers, and Lantheus has already pulled its own 2026 outlook because of it.
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The Regulator340 million dollars: that is how much more Medicare will pay the nation's inpatient rehabilitation hospitals next year, under a final rule the Centers for Medicare and Medicaid Services published in the Federal Register today.
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The Service LineCMS's two most recent report cards on its own ACO REACH model, published days apart in July, tell operators two different stories about the model roughly 115 accountable care organizations (ACOs) are being asked to decide whether to extend into a ten-year commitment.
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The Ledger38 percent: that is how much Dupixent's global sales jumped last quarter, pushing the eczema and asthma drug past 6 billion dollars in a single quarter for the first time, as Regeneron beat Wall Street on both the top and bottom line.
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The Regulator5 million: that is how many Americans HHS's own estimate says will lose Affordable Care Act marketplace coverage by 2030, under a rule 22 states sued to block this week.
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The Ledger1.5 billion dollars: that is what a Swiss plasma-therapeutics maker just locked in for its first-ever US factory, a deal that nearly died in a weeks-long fight over who pays for it.
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The Regulator330 million dollars: that is how much of the federal government's own appropriated budget for patient-safety research is sitting unspent, after the Trump administration quietly stopped funding the agency built to keep American health care safe.
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The Service LineOn July 14, 2026, the Federal Trade Commission finalized a settlement with CVS Health's Caremark Rx and its group purchasing arm Zinc Health Services, resolving the agency's administrative antitrust case alleging the PBM's rebate driven formulary design artificially inflated insulin list prices.
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The Ledger60,000 patients: that is how many UHealth patients keep their in-network access after a deal reached today ended a standoff this issue has tracked since July 27.
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The Regulator60 million dollars: that is how much more Medicare will pay the nation's inpatient psychiatric hospitals next year, under a final rule the Centers for Medicare and Medicaid Services published in the Federal Register today, which also caps how much certain facilities can collect on their most expensive patients.
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The Service LineThe Service Line issue for July 31, 2026.
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The Ledger71.7 billion dollars: that is what Cigna took in last quarter, the health services giant's first earnings report under a new chief executive, and investors got a raised profit forecast to go with it.
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The Regulator26 states and the District of Columbia: that is the coalition of governments a federal judge told this week to keep preparing for Medicaid work requirements they wanted paused, five months before the rule takes effect nationwide.
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The Service LineA profitable rural Maine hospital is closing its maternity ward anyway, and the numbers show why "keep the volume, lose the delivery unit" is becoming the norm.
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The Ledger1.84 dollars: that is how much Humana just cut its full year profit guidance floor, even after beating Wall Street's second quarter estimates, and the stock sold off anyway.
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The Regulator3.6 billion dollars: that is the size of the Medicare drug-plan subsidy the Trump administration is letting expire after this year, a decision that will raise the standard 2027 premium for millions of beneficiaries with standalone prescription drug coverage.
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The Ledger1.09 billion dollars: that is the profit Centene posted this morning, a swing from a 253 million dollar loss a year ago, after the country's largest Medicaid managed-care insurer got its medical costs under control faster than Wall Street expected.
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The Regulator2 p.m.: that is when a federal judge in Boston is scheduled to hear arguments today on whether the Trump administration illegally narrowed who counts as too medically frail to have to prove they are working to keep Medicaid.
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The Service LineMedicare has never had a standing way to pay for AI software as its own billable service, and CMS's newest hospital outpatient rule proposes creating one for the first time, with radiology and cardiac imaging AI tools making up most of the initial list.
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The Ledger7.3 percent: that is how far Universal Health Services' stock fell within hours of beating Wall Street's second quarter revenue estimate, after the hospital and behavioral health operator cut its full year profit guidance.
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The Regulator8 provisions: that is how many pieces of a major Affordable Care Act marketplace rule a federal judge paused last week, days before they were set to reshape how millions of Americans buy 2027 health coverage.
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The Service LineCMS just proposed raising the Medicare payment rate for dialysis treatments above $299 for the first time, while rewriting how facilities get paid extra for new drugs and home training.
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The Ledger5 days: that is how long University of Miami Health System and UnitedHealthcare have left to reach a new network contract before hundreds of thousands of patients go out of network.
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The RegulatorTwo days: that is how long a federal judge in Massachusetts has before deciding whether to block a rule that narrows who counts as too medically frail to have to prove they are working to keep their Medicaid coverage.
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The Ledger416.2 million dollars: that is the record quarterly revenue a thermal management device maker posted this week, and it used the moment to announce a stock buyback nearly three times the size of its old one.
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The RegulatorZero days: that is how much advance notice the Department of Health and Human Services gave hospitals and other federal grant recipients before a rule stripping a major category of civil-rights liability took effect this week.
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The Service LineCMS just proposed adding roughly 618 new procedures to the list Medicare will pay ambulatory surgery centers (ASCs) to perform, the biggest single-year expansion of the ASC growth pipeline in years, while simultaneously choking off the pathway new devices use to get paid extra for using it.
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The Ledger6.12 dollars: that is the adjusted per share profit Tenet Healthcare posted for the second quarter, nearly 1.86 dollars above what Wall Street expected, and investors sent the stock up double digits within hours.
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The Regulator246 billion dollars: that is what the Centers for Medicare and Medicaid Services' own actuaries say a new Medicaid rule will cut from federal spending over the next decade, and the rule's public comment clock started running yesterday.
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The Service LineHome-based care M&A volume just cratered, and dealmakers say the fraud crackdown is why.
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The Ledger2.28 billion dollars: that is the gap between what Wall Street expected Molina Healthcare to earn in 2026 and what the insurer actually guided to, and it wiped out an earnings beat within minutes of the numbers landing.
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The RegulatorA Senate committee capped insulin at 35 dollars a month for privately insured patients yesterday, and today it decides whether Robert F. Kennedy Jr.'s pick to run the Centers for Disease Control and Prevention survives committee.
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The Service LineCMS's proposed 2027 pay rule finishes a four-year psychotherapy pay raise and, in the same document, writes the newest telehealth in-person delay into regulation.
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The Ledger1.272 billion dollars: that is what a private equity buyer is paying to take medical device maker Avanos Medical private today, a 72 percent premium that shows what strategic buyers will pay for a company Wall Street had marked down.
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The Regulator400 million dollars: that is what the Department of Justice agreed to pay Alaska's largest Native-run health system this week, after the federal government spent most of a decade shortchanging it on the cost of running its own health programs.
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The Service Line68.5 percent of U.S. counties, home to 50.8 million people, had no radiation oncology practice site as of 2025, and the counties losing clinics skew rural, poorer and sicker than the ones keeping theirs.
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The LedgerTempus AI agreed to pay 1.5 billion dollars for cancer-testing company Personalis, and Wall Street punished the buyer, not the seller, sending Tempus shares down as much as 8 percent.
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The Regulator774.8 billion dollars: that is what the Centers for Medicare and Medicaid Services itself projects a Medicaid rule will save the government over the next decade, and today is the deadline for the public to weigh in before it can become final.
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The Service LineFive of cardiology and cardiac surgery's biggest specialty societies told CMS this week that stripping the surgeon out of the room for Transcatheter Aortic Valve Replacement (TAVR) approvals goes too far, teeing up a fight before the government's September ruling.
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The LedgerDigital health investors funded fewer companies than dealmakers bought this spring, with 71 corporate acquisitions closing in the second quarter of 2026 alone, the busiest three months for digital health M&A since the height of the 2021 bull market.
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The RegulatorThe Centers for Medicare and Medicaid Services published draft guidance today spelling out how drug manufacturers must actually hand over Medicare's negotiated "maximum fair price" starting in 2028, the first time that mechanic has ever had to work for drugs doctors administer in their offices instead of ones patients pick up at a pharmacy.
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The Service LineThe Centers for Medicare and Medicaid Services (CMS) used its Calendar Year (CY) 2027 Physician Fee Schedule proposed rule, released July 14, to rewrite the math behind every Medicare Shared Savings Program (MSSP) accountable care organization's (ACO's) benchmark, the single biggest primary care policy event since the program's last major overhaul.
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The LedgerIntuitive Surgical beat Wall Street's second-quarter earnings estimates and its stock fell as much as 11 percent anyway, as investors focused on a slowdown in United States surgical procedure growth instead of the headline numbers.
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The RegulatorThe Centers for Medicare and Medicaid Services proposed a rule that raises Medicare's shared savings rate for some accountable care organizations while retroactively imposing a new spending guardrail that delays those same organizations' 2025 reconciliation payments until November 2026.
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The Service LineOne CMS rulemaking season is now reshaping cardiology, radiology, orthopedics, and hospital medicine at the same time, and the throughline is where Medicare wants care to happen.
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The LedgerAn Israeli court will decide by July 19, 2026 whether InMode's board can keep negotiating a buyout led by its own chief executive, after activist investor Steel Partners sued to block the review over a rival, higher, all cash offer.
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The RegulatorA federal judge blocked eight provisions of a Trump administration health insurance rule two business days before they were set to take effect, provisions the Centers for Medicare and Medicaid Services itself estimated could cost up to 2 million people their Affordable Care Act marketplace coverage.
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The Service LineThe Consolidated Appropriations Act (CAA) of 2026, signed February 3, 2026, bars pharmacy benefit managers from earning any Part D compensation tied to a drug's price and requires 100 percent rebate pass-through to plan sponsors, replacing rebate-based pay with a flat "bona fide service fee" that PDP and MA-PD sponsors must enforce starting with the 2028 plan year.
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The LedgerMedtronic paid 650 million dollars in cash to complete its acquisition of SPR Therapeutics, adding an implant-free nerve stimulator for chronic pain to what the company calls the broadest pain-therapy portfolio in the industry.
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The RegulatorCMS will let up to 12 percent of the nation's highest-performing nursing homes skip large parts of their federal inspection starting September 8, cutting survey time roughly in half for facilities that qualify.
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The Service LineThe Service Line issue for July 17, 2026.
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The LedgerUnitedHealth Group's second-quarter profit report beat Wall Street's estimate by roughly 30 percent and pushed its stock up as much as 8 percent, the clearest signal yet that the insurer's yearlong push to control medical costs is working.
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The RegulatorA U.S. House committee voted 42-0 to force Medicare Advantage insurers to speed up and disclose their prior authorization decisions, one of seven bipartisan health bills the same committee advanced in a single markup.
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The LedgerHCA Healthcare cut its full-year profit guidance after preliminary second-quarter results showed a bigger-than-expected hit from patients migrating out of Affordable Care Act marketplace plans, and its stock fell about 6.7 percent.
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The RegulatorCMS proposed cutting Medicare's physician payment rate for 2027, with most doctors facing a bigger cut than physicians in accountable care organizations, and the public has until September 14 to comment.
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The Service LineThe Service Line issue for July 15, 2026.
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The LedgerAn Israeli court just froze InMode's board from deciding on a takeover fight, after the aesthetic-device maker's largest outside shareholder accused management of rigging the sale process in its own favor.
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The RegulatorThe federal government's health care fraud watchdog told Congress this week that it recovered or saved 5.56 billion dollars from Medicare and Medicaid over just six months, a return of 12 dollars and 70 cents for every dollar Congress spends running the office.
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The Service LineCMS wants to pay hospitals only 40 percent of the outpatient rate for basic CT, MRI, and ultrasound scans done at off-campus imaging sites, a direct shot at one of hospital imaging's most profitable corners.
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The LedgerA federal whistleblower lawsuit accuses Alignment Healthcare of manufacturing the Medicare Advantage insurer's first-ever profitable year, and the stock had its worst day in more than two years on the news.
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The RegulatorA federal Medicaid rule that controls billions of dollars in extra payments to hospitals and nursing homes hit a new compliance deadline this week, and a much bigger cut to that same pipeline is now eight days from closing its public comment window.
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The Service LineCMS wants to strip cardiovascular procedures off Medicare's inpatient-only list starting in 2028, and its 2027 outpatient payment rule proposes doubling down on ambulatory surgery centers right now.
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The LedgerMemorial Hermann is shutting down its entire commercial health insurance business, the clearest sign yet that health systems are giving up on owning the payer side of the equation.
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The RegulatorA Los Angeles court permanently shut down the last operators of a fake health insurance scheme that took in payments from more than 14,000 Californians while keeping most of the money for itself.
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The RegulatorA federal accessibility deadline that touches nearly every doctor's office and hospital in the country came due this week, and enforcement exposure starts now.
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The RegulatorA Memphis gynecologist got 20 years in federal prison for reusing unsterilized biopsy devices on more than 15,000 patients and billing Medicare and Medicaid for it.
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The RegulatorThe federal government just opened $281 million in behavioral health grants across 15 programs, with the largest checks going to opioid treatment and school mental health.
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The RegulatorArizona became the 25th state to sue over a Medicaid work rule that strips coverage from some cancer and HIV patients starting July 31.
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The RegulatorCMS proposes cutting hospitals' 340B drug payments by nearly 40 percent while shifting imaging scans to lower, physician-office rates, comments due August 31.
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The RegulatorDOJ and HHS charge 455 defendants in record $6.5 billion health care fraud takedown, with $10 billion in Medicare payments stopped before they went out the door.
No issues in this edition yet.