IRS guidance could cripple new HSA direct primary care access law

By Allison Bell – The One Big Beautiful Bill Act seems to create a way for health savings account users to get primary care without worrying about high deductibles, by using HSA cash to pay for direct primary care practice memberships. But commenters say the Internal Revenue Service may be about to keep OBBBA from letting HSA users have access to no-deductible primary care. The IRS posted a batch of guidance in December 2025 that suggested how it might interpret the OBBA direct primary care membership provision. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Potential Restriction of HSA Benefits: The IRS has issued guidance that may limit the intended benefits of the One Big Beautiful Bill Act (OBBBA), which was designed to allow HSA users to pay for direct primary care memberships without facing high deductibles. Stakeholders argue that the IRS interpretation could prevent workers from accessing no-deductible primary care as Congress intended. This has led to concerns that the law's impact could be significantly reduced if the IRS maintains its current stance.

2. Employer Payment and HSA Eligibility Concerns: Industry representatives have requested that the IRS clarify whether employers can pay direct primary care service arrangement (DPCSA) fees on behalf of employees without affecting their eligibility to contribute to HSAs. There is uncertainty about whether such payments would be considered pre-deductible and if they might inadvertently disqualify employees from HSA contributions. Clear guidance is sought to ensure that employer involvement does not undermine the law’s goal of expanding access to primary care through HSAs.

3. Ambiguity in Definition of Primary Care Services: The IRS guidance currently defines primary care services mainly by listing exclusions, rather than specifying what qualifies as primary care. This approach has been criticized by health care industry leaders, who argue that it creates confusion for both employers and plan administrators. They are urging the IRS to provide affirmative examples and clearer standards to help ensure consistent application of the law and support the expansion of direct primary care access.

Judge orders UnitedHealth to hand over documents in AI coverage denial case

By Jakob Emerson – A federal magistrate judge in Minnesota has ordered UnitedHealth Group to produce a wide range of documents in an ongoing lawsuit accusing the insurer of using an AI algorithm to wrongfully deny Medicare Advantage members post-acute care. The March 9 order largely sided with plaintiffs in their motion to compel discovery, granting or partially granting requests across six of seven categories. The case, originally filed in 2023 by the families of two deceased Medicare Advantage members, centers on UnitedHealthcare’s use of nH Predict, a tool developed by Optum subsidiary naviHealth. In 2024, the company rebranded naviHealth to Home & Community Care. Read Full Article...

HVBA Article Summary

1. Court Orders Broad Discovery: The federal judge's order requires UnitedHealth to provide a comprehensive set of documents related to its use of AI in post-acute care claims. This includes internal policies, analyses of the nH Predict tool, records from its acquisition of naviHealth, and information about government investigations. The court's decision largely favored the plaintiffs, granting most of their discovery requests.

2. Focus on AI's Role in Coverage Decisions: The lawsuit alleges that UnitedHealthcare's AI tool, nH Predict, overrode physicians' decisions and led to premature denials of necessary care for Medicare Advantage members. UnitedHealth and Optum dispute these claims, stating that medical necessity determinations are made by physicians and not by AI. The case highlights ongoing concerns about the transparency and accountability of AI tools in healthcare decision-making.

3. Implications for Industry Oversight: The judge rejected UnitedHealth's attempt to limit discovery to documents after July 2019, recognizing the potential relevance of earlier records as circumstantial evidence. The order also references a recent Senate investigation that found an increase in denial rates after the deployment of naviHealth and nH Predict. This case could set a precedent for how courts handle discovery and oversight in cases involving AI-driven healthcare decisions.

How GLP-1 weight loss compounders reshaped the drug industry

By Shelby Livingston and Ngai Yeung – Hims won — for now. Since 2022, telehealth companies and compounding pharmacies have brought a new type of competition for drugmakers. Pharma giants, long protected by patents and market exclusivity, suddenly found themselves undercut on price by compounded GLP-1 drugs. The compounders helped create an unprecedented craze for the drugs and potentially set a precedent for wrangling future expensive brand-name medicines away from the traditional supply channels. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Hims and Novo Nordisk Settle Dispute Over Compounded GLP-1 Drugs: Hims and Novo Nordisk reached an agreement ending their legal conflict over compounded versions of GLP-1 medications. Under the deal, Hims will stop advertising compounded GLP-1s and prescribe them only on a limited basis while instead offering Novo’s brand-name treatments at discounted cash prices. In exchange, Novo dropped its lawsuit, resolving a dispute that began after Hims launched a compounded Wegovy pill for as little as $99 per month shortly after Novo introduced its own version.

2. Compounded GLP-1s Drove Significant Revenue Growth for Hims: Hims expanded rapidly by offering compounded semaglutide in May 2024 while branded GLP-1 drugs such as Ozempic, Wegovy, Mounjaro, and Zepbound were on the FDA shortage list. The company reported that more than 70% of its $2.2 billion in U.S. revenue came from personalized offerings that may include compounded formulations, up from about half in 2024. Hims also projected that its weight-loss business—including oral medications and GLP-1 treatments—would generate at least $725 million in revenue.

3. Competition From Compounders Influenced Pricing and Sales Models: The growth of compounded GLP-1 alternatives increased pressure on pharmaceutical companies to adjust pricing and distribution strategies. Novo Nordisk introduced a Wegovy pill with a cash price starting at $149 per month, and by early February more than 170,000 patients were already using the medication, most paying cash. The competition also contributed to the expansion of direct-to-consumer programs from major drugmakers and telehealth partnerships designed to connect patients with prescriptions and home delivery.

One-third of Americans cut back on other expenses to cover healthcare in 2025, survey shows

By Sriparna Roy – Roughly one-third of Americans cut back on food, utilities or other daily expenses to pay for healthcare last year, research from the West Health-Gallup Center showed on Thursday, as steeper prices and ‌rising living costs hit households. A nationally and state-representative survey of nearly 20,000 U.S. adults in all 50 states and in the District of Columbia, conducted from June to August 2025, found that 33% of respondents had made at least one trade-off in daily expenses to pay for healthcare. Read Full Article...

HVBA Article Summary

1. Financial Sacrifices Across Insurance Status: The survey revealed that Americans without health insurance are especially likely to make financial sacrifices to afford healthcare, with a majority reporting they had to cut back on essential expenses. Even among those with insurance, a significant portion still reported making trade-offs, indicating that coverage does not necessarily shield individuals from high healthcare costs. This highlights the widespread impact of healthcare expenses across different segments of the population.

2. Rising Costs and Health Implications: The article notes that Americans are facing higher premiums and out-of-pocket costs, particularly after the expiration of pandemic-era subsidies for government-subsidized plans. As healthcare costs rise, there is also an observed increase in the incidence of metabolic diseases, depression, and anxiety, suggesting that financial strain may be contributing to worsening public health. The combination of increasing costs and declining health outcomes presents a growing challenge for both individuals and the healthcare system.

3. Long-Term Life Decisions Affected: Additional survey data show that healthcare costs are influencing major life decisions for many Americans, such as delaying retirement, postponing job changes, or putting off significant purchases like homes or vacations. Nearly 9% of respondents reported postponing retirement due to healthcare expenses, while even more delayed changing jobs. These findings suggest that the burden of healthcare costs extends beyond immediate financial sacrifices and can have lasting effects on individuals' life trajectories.

AMA: Physicians' use of AI doubled from 2023 to 2026

By Dave Muoio – Physicians’ use of artificial intelligence has more than doubled since 2023, with 81% surveyed by the American Medical Association reporting that they currently use the technology in a professional context. Further, nearly 1,700 physician respondents queried in January and February reported, on average, 2.3 use cases. This was also up from 1.1 average use cases in 2023, when the organization first began its near-annual polling on the topic. The most common among the physician users were applications focused on documenting clinical care and summarizing medical research. Read Full Article...

HVBA Article Summary

1. Rapid Growth in AI Adoption and Use Cases: The AMA survey indicates a significant increase in both the number of physicians using AI and the variety of ways they are applying it in clinical practice. The most common uses include documenting clinical care and summarizing medical research, reflecting a shift toward integrating AI into daily workflows. This trend suggests that AI is becoming a standard tool for many physicians, not just a niche technology.

2. Mixed Sentiments: Optimism Coupled with Caution: While physicians’ confidence and excitement about AI have grown, there remains a notable level of caution, especially regarding patient privacy and the potential for skill loss. Many doctors believe AI can improve work efficiency and diagnostic ability, but concerns persist about its impact on patient-physician relationships and data security. The survey highlights that most physicians want to be involved in decisions about AI adoption and see clear regulatory frameworks as essential for building trust.

3. Concerns About Skill Loss and Training: A large majority of physicians express concern that reliance on AI could lead to skill degradation, particularly among medical students and early-career doctors. Although fewer physicians are personally worried about losing their own skills, the issue is more pronounced among those newer to the field and in primary care. These concerns underscore the need for ongoing education and thoughtful integration of AI to ensure that clinical expertise is maintained alongside technological advancement.

Aetna to pay $118M to resolve Medicare Advantage upcoding allegations

By Jakob Emerson – Aetna has agreed to pay $117.7 million to resolve allegations that it violated the False Claims Act by submitting or failing to withdraw inaccurate diagnosis codes for its Medicare Advantage enrollees in order to increase payments from CMS. The settlement comes amid a wave of federal scrutiny over risk-adjustment practices across the MA industry this year alone, following a record $556 million settlement with Kaiser Permanente in January and an ongoing enrollment sanction threat against Elevance Health. Read Full Article...

HVBA Article Summary

1. Federal Scrutiny of Medicare Advantage Practices: The settlement with Aetna is part of a broader trend of increased federal oversight of risk-adjustment and coding practices within the Medicare Advantage industry. Recent actions, including a record settlement with Kaiser Permanente and threats of enrollment sanctions against other insurers, highlight the government's focus on ensuring accurate reporting and billing. This scrutiny is likely to continue as authorities seek to prevent improper payments and protect the integrity of federal healthcare programs.

2. Details of the Allegations and Settlement: The largest portion of the settlement addresses Aetna's chart review program for payment year 2015, where the company hired coders to identify and submit additional diagnosis codes from medical records. Another part of the settlement resolves allegations that Aetna submitted or failed to delete inaccurate morbid obesity codes for members whose body mass index did not support such diagnoses. These actions allegedly resulted in inflated payments from CMS, and the settlement includes a whistleblower component, with a former auditor receiving a portion of the funds.

3. Aetna's Response and Industry Implications: Aetna has stated that it disagrees with the Department of Justice's allegations and does not admit liability as part of the settlement. The company emphasized that resolving the case allows it to avoid prolonged litigation and focus on its Medicare Advantage operations. This case underscores the importance for insurers to maintain rigorous compliance and documentation standards to avoid similar legal and financial consequences.

Inside Microsoft’s strategy as it doubles down on healthcare ambitions

By Patrick Kulp – While ambulance chasing is typically associated with the legal profession, now, between a cohort of medically minded copilots and new tools for doctors and nurses, Big Tech companies seem to be racing toward hospitals. A top player in this sprint is Microsoft, which has edged into health systems already with its enterprise and cloud chops coupled with key partnerships and acquisitions. Meanwhile, the company sees patient-facing health use cases as a chance to differentiate its comparatively fledgling consumer AI business in a crowded space. As part of a new series on Big Tech’s encroachment into healthcare, we’re taking a look at Microsoft’s strategy and what it means for both the tech and the healthcare industries. Read Full Article...

HVBA Article Summary

1. Microsoft’s Deepening Healthcare Focus: Microsoft has made healthcare a central pillar of its AI ambitions, as evidenced by major investments like its $16 billion acquisition of Nuance. The company is leveraging its strengths in enterprise software and cloud infrastructure to integrate AI tools into both patient-facing and provider-facing healthcare settings. This approach aims to address longstanding inefficiencies and outdated technologies within the healthcare sector.

2. Market Timing and Industry Drivers: The healthcare industry’s openness to new technology has increased due to pandemic-driven changes and the rapid advancement of generative AI. Experts note that the sector’s vast administrative costs and overburdened workforce make it an attractive target for automation and AI-driven solutions. The market for AI in healthcare is projected to grow significantly, with estimates suggesting a 44% annual increase through 2034, reaching over $1 trillion.

3. Competitive Landscape and Integration Challenges: Microsoft’s established presence in hospital back-offices and partnerships with major electronic health record providers, such as Epic Systems, give it a substantial advantage in the healthcare AI race. However, integration barriers remain high due to siloed data infrastructures and the significant costs associated with switching systems. While Microsoft focuses on broad enterprise solutions, smaller startups may offer more agile and specialized tools, highlighting the complexity and competitiveness of the healthcare technology landscape.