CMS pauses hospice, home health Medicare enrollments in fraud crackdown
fiercehealthcare - The Trump administration has issued a six-month moratorium on hospice and home health agencies enrolling in Medicare as part of its efforts to combat fraud.
AI Summary: CMS has suspended new Medicare enrollments for hospice and home health providers nationwide amid a fraud crackdown, pausing approvals while investigators audit suspicious applications and billing patterns. The freeze seeks to protect patients and taxpayer dollars, though it may delay access where new providers were expected to step in — because apparently some providers preferred creative billing over care.
- Nationwide moratorium on hospice and home health enrollments (4)
- Policy and patient access fallout from the freeze (3)
- White House fraud crackdown and enforcement sweep (4)
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Nationwide moratorium on hospice and home health enrollments
Policy and patient access fallout from the freeze
White House fraud crackdown and enforcement sweep
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Optum Rx unveils new transparent PBM model
fiercehealthcare - UnitedHealth Group's pharmacy benefit manager, Optum Rx, is making the shift to a more transparent model, the company announced Monday.
AI Summary: Optum Rx unveiled a new pharmacy benefit model that separates drug list prices from PBM fees and adopts clearer pass‑through pricing. Aimed at employers and payers fed up with opaque pharmacy economics, the proposal promises simpler contracts and fee clarity — an attempt to make PBMs boringly accountable and maybe slightly less profitable.
- Industry responses to rising drug costs and PBM models (4)
- Lawmakers and states press PBM vertical-integration reform (4)
- Optum Rx unveils transparent PBM model (4)
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Industry responses to rising drug costs and PBM models
Lawmakers and states press PBM vertical-integration reform
Optum Rx unveils transparent PBM model
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Healthcare bankruptcies increased 33% in Q1: 6 things to know
Andrew Cass / beckershospitalreview - Healthcare Chapter 11 bankruptcy filings rose to 12 cases in the first quarter of 2026, up from 9 cases in the fourth quarter of 2025, according to an April report by Gibbins Advisors. The report analyzed Chapter 11 bankruptcy filings with liabilities of …
AI Summary: A new report finds healthcare bankruptcies rose 33% in the first quarter, underscoring mounting financial pressure across providers from squeezed margins, rising expenses and a tricky reimbursement environment. The surge raises concerns about patient access, consolidation and creditor fallout, and suggests policymakers and executives may need to stop pinching pennies and start fixing structural problems.
- Budgeting, Labor and Management Fixes Under Strain (5)
- Closures, Downgrades and State Rescue Responses (4)
- Q1 Bankruptcy Surge: Numbers and Sector Breakdown (3)
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Budgeting, Labor and Management Fixes Under Strain
Closures, Downgrades and State Rescue Responses
Q1 Bankruptcy Surge: Numbers and Sector Breakdown
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A new Medicare option for weight loss drugs is coming: Here's what to know
Jackie Fortiér / npr - Millions of people with Medicare will soon be eligible to get discounted GLP-1 drugs for weight loss. Here's how it will work.
AI Summary: Medicare is introducing a new option to expand access to weight‑loss medications for older Americans, outlining eligibility, coverage mechanics and likely impacts on beneficiaries and budgets. The guidance aims to help clinicians and patients navigate coverage decisions and prepares stakeholders for shifts in prescribing patterns and costs as demand for GLP‑1 class drugs remains high.
- Competition, dosing and long-term weight strategies (4)
- Efficacy and safety of GLP‑1s in older adults (3)
- Medicare expansion and coverage landscape (3)
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Competition, dosing and long-term weight strategies
Efficacy and safety of GLP‑1s in older adults
Medicare expansion and coverage landscape
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UCB bets $2 billion on Candid's T cell engager ambitions
Kyle LaHucik / endpoints - Ken Song has done it again. The biopharma veteran's all-out effort to prove T cell engagers' potential in autoimmune diseases is getting picked up by one of Europe’s oldest pharma companies. UCB is paying $2 ...
AI Summary: UCB has struck a roughly $2 billion deal to acquire Candid, betting heavily on Candid’s T‑cell engager platform to reset immune‑based oncology programs. The acquisition boosts UCB’s immuno‑oncology pipeline and signals intensified competition in T‑cell engager development, with investors and researchers watching closely to see how science translates into clinical wins.
Sanford Health unveils deal to integrate Minnesota-area North Memorial Health, invest $600M
fiercehealthcare - The deal, expected to close later this year, is another attempt from the major rural nonprofit system to enter the Minneapolis market. To do so, it plans a $600 million investment into two-hospital North Memorial Health that will help stabilize one financ…
AI Summary: Sanford Health announced a plan to integrate Minnesota-area North Memorial Health with a $600 million investment, creating a combined system aimed at expanding services, streamlining care and gaining scale. The transaction is part of a broader wave of regional healthcare consolidation as systems chase efficiency and market presence.
Staffing firm Cross Country Healthcare to be acquired by Knox Lane for $437M
fiercehealthcare - The deal would bring the 40-year-old, publicly traded company under a growth-oriented investment firm with a prior background in healthcare staffing.
AI Summary: Staffing firm Cross Country Healthcare agreed to be taken private in a $437 million deal by private equity buyer Knox Lane, ending its public-company chapter. The acquisition positions the firm for strategic repositioning and could reverberate across hospital staffing markets as investors consolidate workforce services.
Amwell expects smaller losses in 2026 after Q1 performance
Emily Olsen / healthcaredive - The health technology firm’s results give Amwell “increased confidence” it will meet a long-term goal of achieving positive cash flow from operations in the fourth quarter, CFO Mark Hirschhorn said.
AI Summary: Telehealth provider Amwell posted Q1 results showing better-than-expected customer renewals and retention, helping the company forecast smaller losses despite soft revenue. The results suggest operational improvements are stabilizing the business and give investors a slightly less gloomy view of the telehealth market's near-term prospects.
HHS' healthy food agenda puts hospitals on notice about patients' meals
medicalxpress - Complaints about hospital food are certainly not new, and Jell-O and fruit juice are often the butt of related jokes. But the Trump administration has recently upped the ante.
AI Summary: The Department of Health and Human Services is tightening standards for patient meals, signaling hospitals must redesign menus, monitor nutrition policies and prepare for compliance reviews. Facilities face operational and financial pressures to meet healthier food requirements, prompting early planning across dietary services as regulators move from suggestions to enforceable expectations.
- Debate over ultra-processed foods and nutrition science (3)
- HHS healthy food rules put hospitals on notice (4)
- Hospitals struggle with food-as-medicine and cost pressures (4)
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Debate over ultra-processed foods and nutrition science
HHS healthy food rules put hospitals on notice
Hospitals struggle with food-as-medicine and cost pressures
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CVS Health beats the Street with $2.9B in Q1 profit
fiercehealthcare - CVS Health beat the Street on both earnings and revenue in Q1, posting $2.9 billion in profit for the quarter.
AI Summary: CVS Health reported a $2.9 billion Q1 profit, driven by improved performance at Aetna and stronger-than-expected renewals, prompting an upward outlook. Executives point to insurance results and retail stability as drivers — insurance math quietly covering for a retail world that still loves convenience.
WakeMed Health's plans to join Atrium Health face swift pushback from NC officials
fiercehealthcare - A combination unveiled May 1 would bring WakeMed Health $2 billion in promised investment from the major nonprofit system. State officials voiced concerns about the impact of such consolidation and the value of those commitments, delaying a planned go-ahe…
AI Summary: Atrium Health’s plan to fold WakeMed into its system — backed by a roughly $2 billion investment plan — is running into immediate resistance from North Carolina officials. State leaders and local stakeholders have raised concerns about consolidation, competition and community impact, threatening regulatory scrutiny that could delay or reshape the deal. Expect tense negotiations, press statements and a few dramatic headlines.
Centene raises 2026 guidance with strong Q1 revenue, earnings results
fiercehealthcare - Centene kicked off the first quarter with better-than-expected revenue and adjusted earnings results, signaling a recovery from a rough 2025 as the insurer makes progress in managing medical costs.
AI Summary: Centene lifted its 2026 outlook after reporting robust first-quarter revenue and results, signaling confidence in managed care performance and enrollment trends. The company cited favorable operational metrics and market dynamics that supported the guidance bump, reassuring investors even as broader industry headwinds remain in play.
Chiesi signs $1.9B deal to acquire KalVista and its approved drug
Kyle LaHucik / endpoints - Chiesi is buying commercial biotech KalVista Pharmaceuticals for about $1.9 billion in an extension of the industry's vigorous spring shopping spree. The Italian pharma will pay $27 per share {$KALV} in cash to buy the ...
AI Summary: Chiesi Group agreed to buy KalVista for $1.9 billion to secure an approved therapy and expand its rare-disease footprint. The deal transfers marketed assets and R&D capacity, positioning Chiesi to scale rare-disease revenues and invest in next-wave therapeutics — essentially a big check for a bigger strategic play.
Avalyn Pharma Takes a Breath to Raise $300M in IPO Cash for Lung Drug Trials
Frank Vinluan / medcitynews - Avalayn Pharma found strong investor interest in its inhalable drugs in development for two types of pulmonary fibrosis, enabling the company to upsize its IPO. Data from two mid-stage studies are expected in 2027. The post Avalyn Pharma Takes a Breath to…
AI Summary: Avalyn Pharma has substantially increased its IPO, targeting roughly $300 million to bankroll late-stage trials of its respiratory drug candidate. The move reflects strong investor enthusiasm for lung‑disease therapeutics and gives the company a bigger war chest to advance programs previously dependent on venture capital and partnerships.
Cigna exits ACA exchanges despite dramatic profit growth in Q1
Rebecca Pifer Parduhn / healthcaredive - The insurer plans to say goodbye to the ACA exchanges after this year, and is exploring a potential sale of its controversial claims review subsidiary. Both businesses were more trouble than they were worth, executives said.
AI Summary: Cigna announced it will withdraw from Affordable Care Act individual exchanges even after reporting robust first-quarter earnings. The insurer cites strategic and operational reasons for exiting markets where risk and costs bite, a move likely to reduce competition in some states and could leave consumers with fewer plan choices or higher premiums.
FTC moves to shut down health insurance fraud scheme
Jakob Emerson / beckershospitalreview - A federal court has temporarily halted a Florida-based operation that the Federal Trade Commission alleges collected more than $91 million by deceiving consumers into purchasing fake health insurance coverage. The FTC filed its complaint April 7 in the U.…
AI Summary: The Federal Trade Commission filed suit seeking to halt a telemarketing operation accused of selling bogus PPO insurance plans. The action alleges deceptive practices that harmed consumers and triggered enforcement to freeze assets and shut down the scheme, demonstrating regulators still have a pulse when fraudsters find creative ways to sell imaginary “coverage.”
CMS, FDA announce new program to speed up Medicare coverage of breakthrough medical devices
fiercehealthcare - The Trump administration unveiled a new program to speed up Medicare coverage for breakthrough devices, touting that the new pathway cuts red tape for medical device companies to gain reimbursement. CMS said it will pause the existing TCET pathway.
AI Summary: CMS and the Food and Drug Administration launched a coordinated program to accelerate Medicare coverage for breakthrough medical devices, aiming to shorten the gap between regulatory approval and patient access. The initiative aligns agency review processes, defines eligibility, and seeks faster coverage decisions while maintaining safety and evidentiary standards.
- New imaging and monitoring devices promise faster, remote patient care. (3)
- On scene: agencies align to speed device approvals and coverage. (6)
New imaging and monitoring devices promise faster, remote patient care.
On scene: agencies align to speed device approvals and coverage.
Flagging first-quarter volumes dragged CHS’ earnings
Sydney Halleman / healthcaredive - Executives said consumer fears and aggressive denials from payers fueled declining volumes in the quarter, which led CHS to a $58 million loss. Still, the hospital operator said it expects volumes to pick up in the back half of the year.
AI Summary: Community Health Systems reported first-quarter earnings pressured by a steep drop in patient volumes, blaming a surge in payer preauthorization denials for the decline. Executives say the volume shortfall materially weighed on revenue and margins, underscoring how administrative friction between providers and payers can quickly translate into financial pain for hospital operators.
- CHS Q1: earnings hit by volume drops, blame on payers (4)
- Hospitals fight denials: startups, RCM shifts and C-suite focus (4)
- Medicare AI prior authorization pilot causing care delays (3)
- Payers move to standardize prior auth; Congress weighs in (4)
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CHS Q1: earnings hit by volume drops, blame on payers
Hospitals fight denials: startups, RCM shifts and C-suite focus
Medicare AI prior authorization pilot causing care delays
Payers move to standardize prior auth; Congress weighs in
All Other Stories
FDA approves 1st 2-drug HIV treatment
Ella Jeffries / beckershospitalreview - The FDA has approved Merck’s once-daily, two-drug regimen for adults with virologically suppressed HIV-1. The treatment combines 100 mg doravirine and 0.25 mg islatravir and is indicated for patients with no history of virologic treatment failure and no k…
AI Summary: The FDA has approved Merck’s once‑daily two‑drug antiretroviral regimen, marking a notable market entrant poised to compete with established single‑pill therapies. Regulators cleared the novel combination on efficacy and safety data, setting up potential shifts in prescribing, pricing and competition — and giving Gilead something new to grumble about.
CMS delays Part D GLP-1 model amid skepticism from insurers
fiercehealthcare - The Trump administration is delaying a voluntary model that aimed to expand access to GLP-1s in Part D after pushback from insurers.
AI Summary: Federal regulators have paused a Medicare Part D pilot to expand coverage for GLP‑1 weight‑loss drugs amid payer skepticism and implementation concerns. The delay reflects worries about cost, program design and insurer buy‑in, forcing policymakers to revisit the model while patients and providers wait for clarity on whether Medicare will shoulder these high‑price therapies.
- CMS pauses Medicare GLP‑1 BALANCE pilot amid insurer pushback (4)
- Researchers chase GLP‑1 benefits, from gene therapy to Alzheimer’s (6)
- Telehealth and clinics scale GLP‑1 access, delivery and monitoring (3)
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