On April 18, 2023, the U.S. Supreme Court heard oral arguments in two False Claims Act (FCA) cases, which cases center on the necessary state of mind needed to violate the FCA. This Health Capital Topics article will review the oral arguments in the combined cases and how the justices seem posed to rule based on their questions and comments during the session. (Read more...)

On February 22, 2023, UnitedHealth Group’s (UHG’s) Optum division, the health insurance giant’s care delivery arm, acquired Crystal Run Healthcare, a New York based physician group of almost 400 physicians, nurse practitioners, and other providers. This significant move is just the latest in UHG’s concerted effort over the past few years to acquire outpatient providers, surgery centers, and physician groups. This Health Capital Topics article will briefly survey some of the insurer’s recent acquisitions and initiatives to expand their physician services network. (Read more...)

On April 10, 2023, the Centers for Medicare & Medicaid Services (CMS) released its proposed rules for the payment and policy updates for the Medicare inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) for fiscal year (FY) 2024. In addition to a slight payment bump, CMS clarified its stance on physician-owned hospitals and proposed several advances in accordance with the administration’s health equity initiative. This Health Capital Topics article will discuss the proposed rule and the implications for stakeholders. (Read more...) 

As noted in the first installment of this three-part series on the valuation of Medicare Advantage (MA) plans, Medicare enrollment is expected to increase significantly over the next several years. As a result, Medicare spending is expected to nearly double over the same time frame. This Health Capital Topics article discusses the reimbursement and technological environments of MA Plans. (Read more...) 
CHECK IT OUT
IN CASE YOU MISSED IT