North Carolina officials had been quietly laboring for months on an ambitious plan to tackle the state's mammoth medical debt problem when Gov. Roy Cooper stepped before cameras in July to announce the initiative. But as Cooper stood by the stairs of the executive mansion and called for "freeing people from medical debt," the future of his administration's work hung in the balance. Negotiations were fraying between the state and the powerful hospital industry over the plan to make hospitals relieve patient debt or lose billions of dollars of public funding tied to the state's Medicaid expansion. The federal government hadn't signed off on North Carolina's plan, putting funding at risk. And not a single hospital official stood with the governor that day. In exchange for federal money, hospitals would wipe out billions of dollars of patient debt and adopt new standards to shield patients from crippling bills. "It's a model that the rest of the country could adopt," said Jared Walker, founder of Dollar For, a national nonprofit that helps patients get financial aid from hospitals.
Chicago-based Oak Street Health has agreed to pay $60 million to settle allegations that it paid kickbacks to insurance agents in exchange for their help recruiting patients. DOJ alleged that from 2020 to 2022, Oak Street had a program under which third-party insurance agents contacted seniors to market Oak Street to them. Agents would then refer interested seniors to an Oak Street employee through a three-way phone call. Oak Street would then typically pay the agents $200 per beneficiary they referred. The government alleged that Oak Street submitted false claims to Medicare because of violations of the Anti-Kickback Statute. CVS Health, which acquired Oak Street in 2023, noted in a statement Thursday that in the settlement, "There was no admission of — and we expressly deny — any wrongdoing."
Mercy, one of the largest health systems in Missouri, is threatening to stop accepting Anthem insurance unless an agreement on how much the insurer reimburses hospitals for care is reached by the end of the year. Chesterfield-based Mercy, which operates dozens of hospitals and hundreds of other outpatient locations in the region, has announced it intends to move out of the insurer's network in January if Anthem does not agree to a new contract. The contract sets the amount of money the insurer pays hospitals for surgeries, checkups and the thousands of other services the health system provides.
Walgreens has agreed to pay $106 million to settle lawsuits that alleged the pharmacy chain submitted false payment claims with government healthcare programs for prescriptions that were never dispensed. The settlement announced on Friday resolves lawsuits filed in New Mexico, Texas and Florida on behalf of three people who had worked in Walgreens' pharmacy operation. The pharmacy chain was accused of submitting false payment claims to Medicare, Medicaid and other federal healthcare programs between 2009 and 2020 for prescriptions that were processed but never picked up.
Elevance Health, the parent of more than a dozen state Blue Cross Blue Shield plans, is purchasing Indiana University Health's insurance business in a deal that would increase its dominance in several key cities in the state. IU Health's decision to sell is the latest and most prominent example of hospital systems giving up on the idea that they can be both a provider and payer of care. Financial terms of the deal weren't disclosed, and IU Health declined to answer questions from STAT.
A key Senate Republican dismissed the idea that the Affordable Care Act can be repealed next Congress, despite former President Trump's interest in the issue. If Republicans take control of the Senate after November's election, Sen. Bill Cassidy (R-La.) would likely be in charge of the Senate's health committee, which would share responsibility for changes to the ACA. He says any comprehensive healthcare reforms would have to be bipartisan, and noted that repealing the ACA would be a nonstarter among Democrats.