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Providers can't sue state Medicaid agencies over rates, Supreme Court rules

Providers can't sue state Medicaid agencies over rates, Supreme Court rules

Private healthcare providers cannot sue state Medicaid agencies over low reimbursement rates, the U.S. Supreme Court decided Tuesday in a 5-4 decision, reversing a lower court's ruling.

Q&A: Insurers don't want to share savings from reduced utilization

By Modern Healthcare  |  March 28, 2015
Q&A: Insurers don't want to share savings from reduced utilization

Modern Healthcare recently spoke with Dan Wolterman, president and CEO of Houston-based Memorial Hermann Healthcare System, about accountable care, tensions with insurers over starting a health insurance arm, and Memorial Hermann's shift to outpatient care.

Police: Prisoner takes guard's gun, escapes from Va. hospital

By Associated Press  |  March 31, 2015
Police: Prisoner takes guard's gun, escapes from Va. hospital

A prisoner being treated at a northern Virginia hospital wrestled with a guard and took her gun before escaping in a hospital gown and fleeing in a carjacked vehicle, prompting a hospital lockdown and a massive search, police said.



Providers

Demand grows for care coordinators

Demand grows for care coordinators

A growing number of health systems, accountable care organizations and medical home-style practices are deploying care coordinators—which some call navigators. That is changing how patients get care and it's changing the jobs of doctors, nurses and other front-line providers.

Insurance

Network squeeze: Controversies continue over narrow health plans

Network squeeze: Controversies continue over narrow health plans

Narrow-network health plans have grown in popularity, particularly on the Affordable Care Act's insurance exchanges, because their cheaper premiums appeal to price-sensitive consumers, but there is significant consumer and provider dissatisfaction with how many of these plans are organized.

Government

Supreme Court to hear case on insurer reimbursements

The Supreme Court announced Monday it would hear a case centering on this question: If a plan's beneficiary wins money in court for an injury but then spends all that cash, should the beneficiary still have to reimburse his insurance plan for medical expenses it paid?

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