Humana, one of the country’s largest Medicare Advantage organizations, is suing the Centers for Medicare & Medicaid Services over its 2025 star ratings results. In a lawsuit with nonprofit trade association Americans for Beneficiary Choice, the insurer said the federal government's “arbitrary” actions violates the Administrative Procedure Act. “The data and calculations underlying the annual star ratings are dizzyingly complex, and at a first glance, this suit may appear to be a dry disagreement over technical details,” the health plan said. “It is anything but.”
AHA pushes for hospital-at-home changes
The American Hospital Association wants Congress to expand hospital-at-home care and enact reforms on telehealth. AHA President and CEO Rick Pollack encouraged federal lawmakers to extend the CMS waiver for acute hospital care at home through 2029 and lift restrictions on telehealth providers. He hopes Congress will make the changes during the lame-duck session after the election.
The country’s three largest Medicare Advantage (MA) insurers obstruct seniors’ ability to receive post-acute care, a scathing report from the U.S. Senate Permanent Subcommittee on Investigations shows. It outlines attempts from UnitedHealthcare, CVS and Humana—which collectively cover nearly 60% of all MA enrollees—to use technology to reject prior authorization claims, all while reaping profit.
Rising healthcare costs are an alarming concern to the U.S. economy. Our national health expenditure grew from $4.1 trillion in 2020 to $4.5 trillion in 2022, accounting for 17.3% of the country's gross domestic product. These are unfathomable numbers for the layperson, but for an economist, these portend an upward trend that places a significant burden on both the government and individuals. Individuals and families often face high out-of-pocket costs, and many employers are facing escalating expenses, which can impact wages and job growth. Medicare spending is also projected to grow.
The HLTH 2024 conference will kick off Sunday in Las Vegas with an expected 12,000 attendees from across the industry to plot the future of healthcare innovation. Highlighted speakers during the conference include executive leaders from health systems, payers and digital health startups along with investors and non-traditional players like Kroger and Walgreens. Key policymakers, such as HHS Deputy Secretary Andrea Palm, also will take the stage to talk about the regulatory landscape.
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