Healthcare fraud enforcement ramps up in the Trump administration, with implications for all stakeholders
Even as hospital leaders consider how to manage decreased reimbursement and higher costs, federal fraud enforcement continues to have some of the most significant financial stakes of any healthcare industry issue. Rather than taking a hands-off approach, the Trump administration is maintaining and even expanding the Biden administration’s push in this area. Two months ago,…
What DOGE’s actions mean for U.S. healthcare
HFMA Senior Editor Rich Daly talks about his hfm cover story about DOGE and the healthcare industry. HFMA’s Nick Hut and Shawn Stack talk about the 340B drug pricing program.
New processes for Medicare patient-status appeals have arrived, with implications for finance teams (updated)
If they have not done so already, hospitals should establish processes for responding to new regulations concerning status-appeal rights for Medicare beneficiaries. The regulations have taken effect in early 2025 after being published in an October 2024 final rule. That rule stemmed from the outcome of litigation that had begun 15 years earlier. Per the…
HHS concedes defeat in litigation over providers’ use of tracking technologies on websites
The hospital lobby cemented its victory in litigation about online tracking tools after HHS canceled its planned appeal. In June, the American Hospital Association (AHA) and co-plaintiffs won a decision in a Texas federal court about 2022 guidance (revised and somewhat softened in 2024) instructing hospitals and other HIPAA-covered entities to avoid using online tracking…
Johnson & Johnson looks to make a big change in how hospitals obtain 340B price discounts (updated-2)
Note: This article was most recently updated Oct. 1 with information on Johnson & Johnson’s change of plans regarding a proposed 340B rebate program. See that update below. A leading drug manufacturer opened a new chapter in the fight with hospitals over the 340B Drug Pricing Program, requiring the use of a rebate program to…
Optimizing 340B participation compliantly while “waiting and watching” new developments
Since 1992, the 340B program has required drug manufacturers to provide eligible healthcare organizations and other covered entities with drugs to be used for these organizations’ outpatients at significantly reduced prices, with the intent of helping safety net organizations improve their financial stability. In turn, hospitals are expected to demonstrate that the savings they receive…
HHS issues regulations to strengthen anti-discriminatory protections in healthcare (updated)
July 3 update A judge with the Southern District of Mississippi federal court granted an injunction preventing the Biden administration from enforcing regulations expanding anti-discrimination protections in the Affordable Care Act (ACA). Issued two days before the new rule was to take effect, the order applies to the provisions concerning gender identity. The move came…
The FTC’s new non-compete regulations will affect hospital agreements with physicians, unless courts intervene
Hospital advocates expressed concern about the implications of new federal regulations that prohibit employers from including non-compete clauses in employment agreements. Although tax-exempt hospitals largely fall outside the jurisdiction of the Federal Trade Commission (FTC), which will enforce the regulations, the newly issued final rule stands to affect clinical staffing. Non-compete agreements apply to between…
How a health system goes above and beyond in its price transparency efforts
By maintaining a patient-centric perspective, hospitals and health systems can find opportunities to look beyond regulatory requirements and incorporate top-class price transparency models, according to a recent online discussion. “We want to, first and foremost, empower and equip our customers to make informed decisions about their healthcare services and really shop for the best value,”…
CMS calls for hospitals to be subject to a new bundled payment model and data-reporting requirements
Notable policies in Medicare’s FY25 proposed rule for inpatient hospital care and long-term care hospitals include the formation of a mandatory bundled payment model and requirements for hospital data reporting. Although the proposed payment rate was the headlining aspect of the rule for hospitals, the policy developments could have a longer-term impact on segments of…