Medicare Advantage enrollment continues to grow and now covers 51.8% of all Medicare-eligible beneficiaries, yet despite 301 insurers participating in the market, enrollment remains heavily concentrated among a small group of national carriers....News
The Supreme Court has extended access to mifepristone, a widely-used and clinically-determined safe drug that is used to induce abortion. The order, issued by Justice Samuel Alito on Monday, holds back restrictions on the drug imposed by the Fifth Circuit Court of Appeals.
The case at hand was originally filed by the State of...Arizona News
With the Medicaid work requirement guidance deadline looming, the advisory panel that reports to Congress on Medicaid voted to recommend that the Centers for Medicare and Medicaid Services (CMS) should develop a plan for monitoring and evaluating Medicaid work requirements and how these policies affect eligibility, enrollment, spending,...National News
Industry leaders and health sector lobbies are lining up to support the Medicare Advantage Improvement Act (MAIA) of 2026, a bipartisan bill that addresses structural issues within Medicare Advantage.
The bill focuses on critical issues with billing and coverage like prior authorization, payment timing, and billing transparency. The...National News
Humana will move forward on cutting supplemental benefits offered in its Medicare Advantage in response to a lower-than-expected base payment increase in federal reimbursement and a difficult first quarter due to a lower 2026 Medicare Advantage Star Rating.
Earlier this month, the Centers for Medicare and Medicaid Services (CMS)...
Dignity Health's East Valley hospitals, Arizona's Mercy Gilbert Medical Center and Arizona General Hospital in Mesa joined the 5-star lineup along with HonorHealth Scottsdale Thompson Peak and Banner Goldfield Medical Center in Apache Junction, the Mayo Clinic in Phoenix, and VA Medical Centers in Phoenix, Prescott and Tucson. Valleywise...
New analysis from Families USA shows that hospitals are charging commercial plans far more than what Medicare pays for services, highlighting the hospital industry's role in rising medical costs.
The four largest hospital systems in the country use their market dominance to overcharge customers relative to the Medicare rate, Families...National News
The Affordable Care Act health insurance exchange has taken a major hit in the first quarter of the year, according to earnings reports from large insurers, largely due to the expiration of enhanced premium subsidies that kept plans affordable for many enrollees.
In aggregate, health insurers expect enrollment will shrink by at least...CMS Rules
The Centers for Medicare & Medicaid Services is temporarily halting approvals of new hospice and home health agencies nationwide for six months, an unusually aggressive anti-fraud action that carries particular relevance in Arizona, one of the nation’s fastest-growing hospice markets in recent years.The six-month moratorium marks...National News
Aetna stabilized in the first quarter (Q1) of the year after a rocky 2025, bolstering parent company CVS Health's report. The improvement was directly related to the company's government-affiliated businesses, including Medicare Advantage (MA), Medicare Supplement plans and Medicaid managed care.
In a quarterly report released this...White Papers, E books, Reports and more
A new study published investigated federal oversight of Medicare Advantage (MA) plans and the scope of enforcement actions taken against insurers that violate federal standards. It found that enforcement actions were limited, raising concerns for regulatory effectiveness.
The study, published in JAMA Internal Medicine, was prompted by...National News
President Donald Trump has selected a new nominee for Surgeon General after pulling another after backlash to the another MAHA movement candidate.
President Trump initially nominated Casey Means, a wellness entrepreneur, physician and published author associated with the Make America Healthy Again (MAHA) movement that believes...National News
The Centers for Medicare and Medicaid Services (CMS) accidentally posted the Social Security data for 100 healthcare providers in the National Provider Directory.
The issue was initially noticed by the Washington Post, which reported that the publicly accessible database contained Social Security numbers linked to providers' names....Arizona News
A new federal healthcare fraud task force will tackle Medicare and Medicaid fraud on the West Coast, including states like Arizona and Nevada, in addition to California.
The Centers for Medicare and Medicaid Services (CMS) has a new data analytics system that will be deployed with the "West Coast Health Care Fraud Strike Force" to...White Papers, E books, Reports and more
Accountable care organizations (ACOs) are facing growing financial exposure from fraud and questionable billing outside their networks, as Medicare pushes participants to take on greater accountability for total cost of care, according to a new analysis from Milliman.
Under MSSP and ACO REACH, ACOs are responsible for all...News
Federal spending on children continues to shrink as a share of the budget and the broader economy, even as total spending grows, according to a new Urban Institute analysis.
The year's annual report finds the federal government spent $533 billion on children in 2024, about 8% of total spending, a share projected to fall to 6% by 2035....News
The initiative, housed within AHA’s Health Research and Educational Trust, will provide participating hospitals access to implementation support for the use of the West Health Accelerator, a digital hub of proven solutions, and peer learning networks designed to move technologies from pilot to systemwide adoption.
The new project...White Papers, E books, Reports and more
In this report from Georgetown University, analysts reviewed five state employee health plans (SEHPs) facing the same significant increases as commercial healthcare costs: rising prices. As commercial healthcare costs rise and employer-sponsored insurance has grown increasingly unaffordable for employers and their employees, researchers...Arizona News
The project expands the hospital from 204 to 238 beds and adds a new four-story patient care pavilion, along with additional operating rooms and upgraded surgical and patient spaces. Final elements are expected to be completed later this year, with a full opening planned in 2026.
The $170 million renovation and expansion at Deer...
We hope you'll join The Hertel Report healthcare community for our final happy hour of the spring season. It's a great time to reconnect with colleagues and meet new healthcare professionals at the Healthcare Happy Hour in Midtown Phoenix on Thursday, May 14, 2026.
Sponsored by Titanium Healthcare
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In a motion filed in Maricopa County Superior Court, Sharareh Najafi-Piper, the former CEO of Mesa-based Copa Health, called claims of misuse of funds by her former company are “provably false” and argued the case should be handled through confidential arbitration, as required under her executive employment agreement. The filing asks...CMS Rules
The Regulatory Alignment for Predictable and Immediate Device (RAPID) coverage pathway is designed to streamline communication from the Centers for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA) to manufacturers in the early stages of product development, allowing Medicare beneficiaries to participate in...Arizona News
The Arizona, mostly non-profit insurer, also suffered a $162.2 million loss in 2024, reversing a $85.4 million net income gain in 2023. In more bad news for the company, billions from an antitrust settlement will begin flowing to consumers across the country from Blue Cross Blue Shield and its member plans, including Blue Cross Blue...National News
The new standards are expected to be adopted by a group that includes Centene, Cigna, Humana, Aetna and UnitedHealthcare and will apply to orthopedic surgeries and imaging services like CTs and MRIs, in addition to other medical services that usually require prior authorization.
Modern Healthcare reports the standards will apply to...Available To All
Health insurers are holding their first quarterly calls with investors for 2026; UnitedHealthcare appears to be back on track after a rocky 2025, and Centene is reportedly holding steady despite losses from surging ACA premiums.
Centene's profits rose 17.5% to $1.5 billion in the first quarter with revenue increasing 7.1% to $49.9...
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