Gov. Gavin Newsom signed legislation giving the California attorney general oversight authority over Kaiser Permanente's medical arbitration system, addressing patient complaints that the system has favored the healthcare giant over patients seeking to resolve disputes.
Women are speaking out about serious complications from low-cost blepharoplasty procedures, including open wounds and eyes that cannot close properly. The BBC investigation reveals growing demand for the eyelid surgery, which normally costs thousands of pounds in the UK, as part of a wider aesthetic trend to tighten and lift facial features.
Multiple telehealth companies offering quick prescriptions for sensitive conditions like weight loss, sexual health, and mental health are repeatedly exposing customers' private medical data due to gaps in U.S. health privacy regulations. The FTC has filed suit against Hims & Hers over data practices and prescribing standards.
A Texas judge approved a wind-down bankruptcy plan for CVS Health subsidiary Omnicare LLC following the sale of its business operations for $250 million and resolution of a nearly $1 billion judgment related to improperly dispensing prescription drugs.
Nearly $12 billion in Medicaid funding has been restored to Texas hospitals, resolving a nearly year-long dispute with the Centers for Medicare and Medicaid Services. The hospitals had been slated to lose $27 million per day during the standoff.
Patrick Velliky, HaloMD's chief external affairs officer, maintains the No Surprises Act is reducing out-of-network spending despite contradictory research, while responding to criticisms of both his analysis and the company.
HHS Office of Inspector General audits found that Humana and UnitedHealthcare Medicare Advantage plans exaggerated the health needs of members through upcoding practices, resulting in nearly $180 million in overpayments between 2020 and 2021.
A new modeling study published in The Lancet suggests that US Medicare's most-favored-nation pricing policy, which ties Medicare payments to prices in other high-income countries, could reduce US spending on brand-name drugs but incentivize pharmaceutical companies to increase prices or delay launches in lower-price markets like Europe.
Planned Parenthood of Wisconsin filed a lawsuit challenging state laws that restrict abortion access, including requirements that only certified physicians perform abortions and a mandatory 24-hour waiting period. The organization argues these laws violate the state constitution.
Texas Attorney General Ken Paxton has launched an investigation into a major military healthcare contractor following complaints about wrongfully denied medical claims. The investigation was announced by Paxton's office this week.
The Justice Department announced an agreement with Mount Sinai Health System to resolve an investigation into potential violations of federal law related to its provision of gender-transition procedures for minors, including puberty blockers, cross-sex hormones, and surgical interventions. The Manhattan hospital network will pay a fine and cease providing these services to children.
The federal government is evaluating methadone clinics two years after implementing major regulatory changes in 2024, following backlash from patient groups and scrutiny from lawmakers over the specialized addiction treatment providers.
Spanish pharmaceutical company Grifols has temporarily halted plasma donations at all 16 of its Canadian clinics following the deaths of two donors and a government investigation into potential unsafe practices at the for-profit facilities.
The 5th Circuit Court of Appeals ruled against key regulations governing how insurers calculate reimbursement rates under the No Surprises Act, finding that the formula improperly favored payers over healthcare providers. The decision prohibits insurers from including ghost rates or excluding bonus payments in the qualifying payment amount used to determine out-of-network billing disputes.
The full Fifth Circuit Court of Appeals dismissed Planned Parenthood's appeal of an interim ruling, allowing a $1.8 billion False Claims Act lawsuit by Texas to proceed in federal district court. The organization says the lawsuit could force it to shut down operations in the state.
The 5th Circuit Court of Appeals ruled that insurers cannot include ghost rates or exclude bonus payments when calculating the qualifying payment amount used to determine reimbursement for out-of-network bills, a major win for healthcare providers that could increase their payments.
Brookings Institution researchers have criticized the Centers for Medicare and Medicaid Services for allegedly using faulty assumptions in a rule that made it harder for sick Medicaid enrollees to prove exemption from work requirements. The rule has already drawn lawsuits.
The Trump administration finalized a rule prohibiting Medicaid and the Children's Health Insurance Program from covering gender-affirming surgeries and hormone treatments for transgender minors, threatening to pull federal funding from states that continue such coverage.
Governor Maura Healey signed legislation eliminating Massachusetts' gestational limits on abortion, giving doctors final say on whether late-term abortions should be allowed. The state joins nine others and Washington, D.C. in removing such restrictions.
The U.S. Department of Health and Human Services announced it will decertify Network for Hope, a Kentucky-based organ procurement organization, following allegations that staff continued with organ retrieval procedures despite patients showing signs of life, including a case where a patient was thrashing, crying, and shaking his head.
UK regulators have authorized the INTERCEPT-Lynch Phase 1/2 trial of mRNA-4194, a preventive cancer vaccine developed by Moderna and the University of Oxford targeting people with Lynch syndrome, an inherited condition affecting 1 in 300 people with up to 80% lifetime cancer risk. The trial will begin dosing in summer 2026.
The Centers for Medicare & Medicaid Services finalized a 2.3% payment increase for inpatient hospitals in fiscal year 2027 and introduced the first nationwide mandatory payment model for joint replacements starting in 2028. Hospital groups criticized the raise as inadequate and objected to the mandatory nature of the new model.
The Michigan Supreme Court ruled 4-3 on July 31, 2026, overturning two lower court decisions and allowing Attorney General Dana Nessel to proceed with an investigation into Eli Lilly's insulin pricing practices under the Michigan Consumer Protection Act.
The Massachusetts legislature passed legislation on the final day of formal sessions that would expand abortion access later in pregnancy by giving physicians final authority to determine medical necessity. The bill now awaits Governor Maura Healey's signature.
Multiple U.S. states are implementing measures to regulate pharmacy benefit management companies that oversee prescription drug coverage for health insurers, as part of efforts to reduce medication costs for consumers.
Elevance Health has paid the federal government more than $342 million to settle allegations that it overcharged Medicare Advantage for years. The payment comes amid an ongoing billing probe into the major insurer, which covers approximately 2 million Medicare Advantage beneficiaries.
The Centers for Medicare & Medicaid Services issued a proposed rule (CMS-2449-P) addressing Medicaid managed care state directed payments and fee-for-service targeted practitioner payments, representing significant changes to how states can direct Medicaid spending.
The Philadelphia Department of Public Health recommended patients at a Rittenhouse Square dental office get tested for Hepatitis B, Hepatitis C, and HIV after the office's license was suspended due to infection control violations.
A key GOP lawmaker is investigating whether the American Medical Association's medical billing codes are contributing to healthcare fraud, broadening Republican efforts to combat fraud in the healthcare system.
Atrium Health, one of the nation's largest hospital networks, has proposed acquiring the Raleigh-based WakeMed system. State and local officials are pressing for a delay on the deal, which became public on May 1.
The Centers for Medicare & Medicaid Services and FDA announced a new pathway to streamline Medicare coverage for breakthrough medical devices, cutting red tape and providing predictability for device manufacturers and faster patient access to life-changing technologies.
Major health care firms and trade groups are spending unprecedented amounts on lobbying as the Trump administration intensifies scrutiny of their business practices ahead of midterm elections, with new disclosures showing record first-quarter spending.
Swiss drugmaker Roche presented latest clinical trial data for its experimental multiple sclerosis drug at a major conference, setting the stage for regulatory approval submissions, though safety questions remain under scrutiny.
CVS Health's Caremark pharmacy benefits unit reached a settlement with the U.S. Federal Trade Commission to curb controversial rebate practices in the pharmacy benefits market. The agreement requires Caremark to count consumer purchases from Trump's TrumpRx program toward insurance deductibles, mirroring a similar settlement previously reached with Cigna.
Bipartisan efforts are emerging at federal and state levels to regulate pharmacy benefit managers (PBMs), with proposals including barring companies from owning both PBMs and retail pharmacies. Two states have already enacted such restrictions, while federal legislation has gained support from both conservative Republicans and progressive Democrats.
