Broker Regulation

A Milwaukee hospital alleges CVS used its control of a PBM, specialty pharmacy and third-party administrator to reduce reimbursements and retain savings intended to support patient care.

Nearly 70% of the estimate rests on payments above an insurer-calculated benchmark that a federal appeals court recently found could be artificially low.

Few people are asking the question that should be driving every discussion: Who remains accountable when AI gets it wrong?

The agency alleged that The Villages Health System, based in the 55-plus community of The Villages in central Florida, submitted false diagnosis codes to increase payments.

Employers often compare administrators by their base fees, but a study finds additional charges can be embedded throughout their contracts and claims.

Lawmakers accused Republicans of preparing benefit cuts, while Speaker Mike Johnson has characterized the undisclosed proposal as an effort to "adjust and fix" mandatory programs.