Healthcare Payers / Providers

Today’s reaction to the WSJ report that UnitedHealth (UNH) is under civil investigation by the DOJ for Medicare False Claims Act violations strikes us as overwrought, with ultimate financial liabilities (still 1-2 years away) unlikely…

While hospices [CHE, ADUS, private Gentiva, Compassus] are receiving a reprieve for now from more intensive oversight and the threat of termination from Medicare after CMS announced it was going to sideline the statutorily mandated…

We expect Humana (HUM) to ultimately prevail in its lawsuit against HHS to secure higher 2025 Medicare Advantage (MA) star ratings, but it may take longer than we originally expected (as early as March-April). While…

As we await the House’s budget reconciliation strategy this week, the Senate FY25 budget resolution proposal released late Friday bolsters our expectations for Medicaid work requirements, which we see as one the most likely Medicaid-related…

With the briefing in a federal lawsuit having concluded and Congress on the hunt for legislative savings, the question is when, not if, CMS’s minimum nurse staffing rule is killed, eliminating the overhang and potential…

We lean against yesterday’s OMB directive for temporarily pausing federal funding for grants, loans and programs applying largely to Medicaid’s payments to the states for Medicaid insurers (CNC, MOH, ELV, UNH, CVS) or for reimbursements…

While investors in insurers and providers seem most concerned about the fate of the expiring enhanced ACA subsidies, which we still expect to be revised but ultimately extended later this year, other – albeit smaller…

We doubt Medicare Payment Advisory Commission’s (MedPAC) FY/CY26 Medicare payment recommendations for home health agencies, inpatient rehab facilities, skilled nursing facilities, hospices, dialysis centers, hospitals, and physician offices, which were voted on Thursday in nearly…

UnitedHealth’s (UNH) comments during its 4Q and full year 2024 earnings call about changes its it taking to head off certain public policy concerns (PBMs, prior authorization/claim denials) seem like the company is in catch-up…

The FTC’s unanimously-supported release of its second interim report on pharmacy benefit managers (PBMs), focused on specialty drug dispensing at affiliated pharmacies [CVS, CI, UNH] that generated an extra $7.3B in revenue over six years,…