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đź’˛ MultiPlan faces price fixing lawsuit

Vaccine exemptions among Kindergartners increases, DEA extends Telehealth prescribing, and more!

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Pulse Points
November 20, 2024

In this edition:

  • 🧑‍⚖️ MultiPlan faces price fixing lawsuit

  • đź’Š DEA extends telehealth prescribing

  • 🥼 Trump chooses Dr. Oz to lead CMS

  • And more!

MultiPlan faces price fixing lawsuit

Community Health Systems, one of the largest hospital systems in the U.S., has become the third health system in less than a year to file a lawsuit accusing MultiPlan of price fixing.

The suit, filed in New York federal court, alleges that the data-driven claims repricing business reached agreements with nearly every other significant payer to suppress out-of-network reimbursements paid to health-care providers.

"MultiPlan knows that by bombarding health-care providers with a constant stream of 'repriced' reimbursement demands, it is practically impossible for health-care providers to meaningfully negotiate or pursue dispute resolution with respect to individual claims," the lawsuit said.

"Accordingly, any 'negotiation' with MultiPlan starts from the position of MultiPlan's collusive offer to radically underpay health-care providers for their services and invariably ends with MultiPlan forcing the health-care provider to capitulate to an extreme underpayment."

DEA extends telehealth prescribing

For the third time, the Drug Enforcement Administration (DEA) has extended the COVID-19 flexibilities that have allowed clinicians to virtually prescribe certain medications through 2025.

In a release Friday, the agency said it needed additional time to consider thousands of public comments about these pandemic-era flexibilities.

“We continue to carefully consider the input received and are working to promulgate a final set of telemedicine regulations. However, with the end of 2024 quickly approaching, DEA, jointly with (Health and Human Services), has extended current telemedicine flexibilities through December 31, 2025,” the agency said in a statement.

Share of kindergartners with vaccine exemptions increases

The share of U.S. kindergartners with vaccine exemptions increased in 40 states plus Washington, D.C., during the 2023-24 school year, according to recently updated CDC data.

Why it matters: The trend is a reflection of increased vaccine skepticism, which has lingered in some parenting corners for years but gained considerable steam during the COVID-19 pandemic.

Driving the news: The share of kindergartners with exemptions for one or more vaccines increased to 3.3% in 2023-24, up from 3% the prior year.

Hospitals are seeing fewer infections

Hospitals and health systems are making important strides in patient safety, according to The Leapfrog Group.

The organization released its Fall 2024 Hospital Safety Grades Friday, and there’s undeniable good news for hospitals, and the patients relying on them. Hospitals saw a significant drop in infections and made gains in reducing medication errors, the report says.

In fact, hospitals are now faring better in patient safety metrics than before the COVID-19 pandemic, says Katie Stewart, director of health care ratings for the Leapfrog Group. The Leapfrog Group, a nonprofit organization focused on patient safety, examined nearly 3,000 hospitals in its latest report. The group releases safety grades twice a year.

Dr Oz is Trump’s pick for CMS

resident-elect Donald Trump has picked Dr. Mehmet Oz to serve as the administrator for the Centers for Medicare and Medicaid Services, a key federal agency that oversees health insurance coverage for more than 150 million Americans.

“I have known Dr. Oz for many years, and I am confident he will fight to ensure everyone in America receives the best possible Healthcare, so our Country can be Great and Healthy Again!” Trump said in a statement on Tuesday. “Dr. Oz will be a leader in incentivizing Disease Prevention, so we get the best results in the World for every dollar we spend on Healthcare in our Great Country.”

Trump, who is also seeking to slash spending in the federal government and has long had Medicaid in mind for reductions, also promised Oz would take a scalpel to the massive agency.

“He will also cut waste and fraud within our Country’s most expensive Government Agency, which is a third of our Nation’s Healthcare spend, and a quarter of our entire National Budget,” the president-elect said in his statement.

Oz, a cardiothoracic surgeon and television personality, ran unsuccessfully for Senate in 2022 in Pennsylvania with Trump’s backing. He lost to Democratic now-Sen. John Fetterman.