About health insurance/insurers
ICYMI: Medicare Advantage fraud in DOJ's crosshairs after agency reports $2.7B in settlements “Under the False Claims Act, more than $1.8 billion in settlements and judgments was related to health-related matters in the last fiscal year, about two-thirds of the monetary fraud recoveries by the Department of Justice (DOJ).
Scams took place across the industry, affecting managed care providers, hospitals, pharmacies and long-term acute care facilities. The agency said Feb. 22 that $1.8 billion refers to recoveries ‘arising only from federal losses,’ but it often recovered more for state Medicaid programs.The total fraud figure jumps to more than $2.68 billion once including all other types of reported fraud.”
About hospitals and healthcare systems
25 unwound, canceled hospital deals FYI
Cooper to begin estimated $2B expansion this year “Cooper University Health Care is preparing to begin the first phase of a projected $2 billion expansion this year, according to Fitch Ratings.
In late 2022, Cooper announced a long-term vision to update its Camden, N.J., campus. The vision comprises three independent phases, with an initial public price of about $2 billion. Fitch said the phased approach gives Cooper the flexibility to pause spending and the ability to reevaluate should market conditions or business strategies change.”
Hospitals show decline in Fitch’s early 2023 analysis, but should improve (a little) “Overall, Fitch expects the 2023 operating margins to rise into positive territory, albeit barely. The 2023 margins are expected to rise to 0.5% to 0.7%, which remains below pre-pandemic levels.
In 2024, Fitch projects margins should move up to 1.6%.
Hospitals are seeing some relief in their labor costs, which have risen substantially since the COVID-19 pandemic.”
About pharma
Biotech's top money raisers of 2023 “Nearly $23 billion in venture capital flowed to biopharma across 613 deals in 2023. The dollar total is down 21% from 2022 and 42% from 2021, according to an annual report from HSBC. The trend was worse for biotechs hunting for their first deal.”
Prices for new US drugs rose 35% in 2023, more than the previous year “Pharmaceutical companies last year launched new U.S. drugs at prices 35% higher than in 2022, reflecting in part the industry's embrace of expensive therapies for rare diseases like muscular dystrophy, a Reuters analysis found.
The median annual list price for a new drug was $300,000 in 2023, according to the Reuters analysis of 47 medicines, up from $222,000 a year earlier. In 2021, the median annual price was $180,000, the 30 drugs first marketed through mid-July, according to a study published in JAMA.”
About the public’s health
U.S. launches probe into possible fraud by organ collection groups “The probe involves U.S. attorneys in various parts of the country who are investigating organ procurement organizations in at least five states. Their team includes investigators from the Department of Health and Human Services and the office of Michael Missal, the inspector general of the Department of Veterans Affairs. They are seeking to determine, among other things, whether any of these groups have been overbilling the government for their costs.”
About healthcare IT
Unveiling Inferno Testing Support for Payer Data Exchange API Standards “ONC has hit a new milestone in advancing interoperability across the care continuum. A new series of voluntary tests to support standards-based application programming interfaces (APIs) leveraging Health Level Seven® (HL7®) implementation specifications developed via the Da Vinci project and the CARIN Alliance are now available in the ONC-developed Inferno testing tool. The tests are open source, with the source code freely available for use by the public on GitHub.”
About healthcare personnel
$1 Billion Donation Will Provide Free Tuition at a Bronx Medical School “Dr. Ruth Gottesman, a longtime professor at the Albert Einstein College of Medicine, is making free tuition available to all students going forward.”
About healthcare finance
Private equity firm offers $5.8 billion buyout of hospital billing company R1 RCM “R1 RCM, a large publicly traded technology company that helps hospitals and physicians collect money from insurers and patients, may be going private.
Private equity firm New Mountain Capital has offered to purchase R1 for $13.75 per share, or roughly $5.8 billion in cash, according to new financial disclosures filed Monday. New Mountain Capital is R1’s second-largest investor, owning nearly one-third of the company’s shares.”