DOJ alleges NewYork-Presbyterian forces payers into anticompetitive 'all-or-nothing' contracts

By Dave Muoio – The Department of Justice has sued NewYork-Presbyterian over payer contracts that allegedly impose anticompetitive restrictions on health insurers’ offerings. The civil antitrust lawsuit against the eight-hospital nonprofit was filed Thursday along with the U.S. Attorney’s Office for the Southern District of New York in its home district. Its claims echo those made by the government last month in similar litigation against 16-hospital nonprofit OhioHealth. “Healthcare is a vital sector of our nation’s economy that touches the life of every single American,” Acting Assistant Attorney General Omeed A. Assefi, of the Justice Department’s Antitrust Division, said in a release announcing Thursday’s filing. Read Full Article...

HVBA Article Summary

1. DOJ Files Antitrust Lawsuit Against NewYork-Presbyterian: The U.S. Department of Justice has filed an antitrust lawsuit alleging that NewYork-Presbyterian used its market power to maintain higher prices and limit competition in the New York City hospital market. The complaint claims the system required insurers to accept “all-or-nothing” contracts that include all of its hospitals and services in their networks. Federal officials argue these arrangements prevent insurers from offering lower-cost or tiered health plans to consumers.

2. Allegations Focus on Market Power and Pricing: The DOJ describes NewYork-Presbyterian as the largest and most powerful hospital system in Manhattan and across New York City, reporting about $10.7 billion in operating revenue in its most recent fiscal year. The government claims the system charges higher prices than competitors such as NYU Langone, Mount Sinai, and Northwell despite offering comparable quality of care. According to the lawsuit, the system’s size, extensive provider network, and strong reputation give it significant leverage in negotiations with insurers.

3. Hospital System Denies Allegations and Defends Contract Practices: NewYork-Presbyterian stated that it believes the lawsuit is without merit and that it complies with all applicable federal and state laws. The organization says it does not attempt to exclude other hospitals from insurer networks and does not seek preferential treatment in contracts. The DOJ is asking a federal court to rule that the alleged practices violate the Sherman Act and to prevent the hospital from continuing similar arrangements.

White House delays permanent CDC director pick

By Peter Sullivan – The White House is indefinitely postponing its selection of a permanent Centers for Disease Control and Prevention director, leaving acting head Jay Bhattacharya overseeing the agency past a key deadline. Why it matters: The punt underscores the difficulty of finding a nominee who can be confirmed by the Senate and leaves the beleaguered public health agency without a full-time political leader. Read Full Article...

HVBA Article Summary

1. CDC Leadership Transition Continues While Search Proceeds: The Department of Health and Human Services said Dr. Bhattacharya will continue overseeing certain CDC responsibilities by performing duties that can be delegated to him. Although he will not formally serve as acting CDC director, this arrangement allows agency leadership functions to continue during the transition. The administration stated that Health Secretary Robert F. Kennedy Jr. and other officials are working with the White House to evaluate candidates for the permanent role.

2. Statutory Deadline Leads to Interim Arrangement: The administration faced a statutory deadline that limited how long Bhattacharya could officially serve as acting CDC director without a formal nomination. To comply with the rule, he will continue carrying out CDC-related duties while not holding the official acting title. Bhattacharya also continues to serve as director of the National Institutes of Health during this period.

3. Policy and Political Considerations Shape Director Search: The delay in naming a permanent CDC director occurs as the administration evaluates policy priorities and leadership compatibility. Reports indicate the administration is reconsidering certain vaccine-related policies while seeking a candidate able to work with Health Secretary Robert F. Kennedy Jr. and broader administration initiatives. Bhattacharya has said in an internal staff discussion that he has had scientific disagreements with Kennedy, reflecting differing viewpoints within the leadership.

10 ACA insurers with the highest claim denial rates: KFF

By Elizabeth Casolo – ACA insurers denied just under 1 in 5 in-network claims in 2024, similar to 2023, according to a March 24 KFF analysis. Only 3% of the insurers had in-network denial rates of at least 30%, down from 17% of insurers in 2023. Unlisted “other” reasons led the share of denials for 2024 at 36%, followed by administrative reasons, at 25%. A lack of prior authorization or referral accounted for 9% of denials, and a lack of medical necessity accounted for 5%. Read Full Article...

HVBA Article Summary

1. KFF Analysis of CMS Transparency in Coverage Data: KFF reviewed the Centers for Medicare & Medicaid Services (CMS) “Transparency in Coverage” public use file, which includes insurers with more than 1,000 claims submitted. Over 150 insurers in HealthCare.gov states met this threshold and reported information on claims received and denied in 2024. The analysis does not include insurers operating solely in state-based exchanges.

2. Highest In-Network Denial Rates Among Large Payers: Among payer parent organizations listed on HealthCare.gov with more than 5 million claims in 2024, denial rates varied across insurers. Oscar Health reported the highest average in-network denial rate at 25%, followed by Molina Healthcare and Guidewell Mutual Holding at 22%. Harris Health, Cigna, and Blue Cross Blue Shield of Tennessee each reported denial rates around 21%.

3. Other Major Insurers Reporting Comparable Denial Rates: Several additional large insurers reported slightly lower but still comparable average in-network denial rates. Blue Cross Blue Shield of North Carolina, UnitedHealth Group, Blue Cross Blue Shield of Alabama, and IHC Group each reported denial rates of about 19%. These figures reflect average in-network claim denial rates reported in the CMS public use file for 2024 claims.

UnitedHealth shareholder sues over proposal to include details on integration in annual proxy

By Paige Minemyer – An activist investor is suing UnitedHealth Group in a bid to pressure the company to include details on the impact of its vertical integration activities in its annual proxy filing. The Quebec-based Congregation des Soeurs des Saints Noms de Jesus et de Marie, a member of the Interfaith Center on Corporate Responsibility (ICCR), filed the lawsuit Friday in the District of Columbia federal court, arguing that proponents of the proposal requested that the healthcare giant publish a report diving into the effects of its acquisitions and integration strategy over the past decade. Read Full Article...

HVBA Article Summary

1. Shareholder Lawsuit Seeks Greater Transparency: The lawsuit was filed by a Quebec-based religious congregation that is part of the ICCR, aiming to compel UnitedHealth Group to disclose more information about the effects of its vertical integration and acquisition strategies. The investors believe that such transparency is necessary for shareholders to understand how these business moves impact both the company and the broader healthcare sector. Their concern centers on the potential risks that extensive vertical integration could pose to the healthcare system.

2. SEC's Role and Policy Shift: UnitedHealth argued to the Securities and Exchange Commission (SEC) that the shareholder proposal constituted impermissible micromanagement of ordinary business matters, and the SEC agreed, issuing a "no objection" letter allowing the company to exclude the proposal from its proxy materials. This reflects a recent change in SEC policy, where the agency now issues "no objection" letters instead of reviewing exclusion requests in detail. As a result, shareholders who feel their proposals are unjustly excluded may increasingly turn to the courts for recourse.

3. Broader Implications for Corporate Governance: The ICCR noted that the SEC's policy change has led to more shareholder lawsuits as investors seek to enforce their rights through legal action rather than regulatory channels. The congregation previously attempted to push for more transparency from UnitedHealth on utilization management, but that effort was withdrawn. This ongoing dispute highlights growing tensions between large corporations and activist investors over the level of disclosure and accountability expected in corporate governance.

Brokers expect rise in sales despite rising administrative complexity

By Joel Kranc – A new research report from the Employee Benefit Research Institute (EBRI) shows that benefits brokers expect growth across core and voluntary products in the year ahead, but say administrative complexity and gaps in education and communication continue to hinder broader employee adoption of voluntary offerings. "The research report findings point to clear opportunities to reduce friction in enrollment and administration and to strengthen education so employers and employees can make more confident decisions about voluntary benefits," said Bridget Bearden, director of membership growth and partnerships, EBRI. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Brokers Expect Growth in Voluntary Benefits Sales: The report “Expanding the Benefits Horizon: How Brokers View Voluntary Offerings” found that 77% of brokers expect health insurance sales to increase over the next year, indicating continued demand for employer-sponsored coverage. Brokers also anticipate growth in group life insurance (64%) and supplemental health products (62%), reflecting broader interest in voluntary benefits that complement traditional plans. These projections suggest brokers see expanding opportunities to offer additional benefits that help employers enhance coverage options for employees.

2. Administrative Complexity Remains a Key Barrier: Nearly half of brokers identified administrative complexity as a major challenge when integrating supplemental health offerings into benefits packages. Brokers reported that complicated enrollment processes, fragmented systems, and limited reporting tools can make it more difficult to manage and implement voluntary benefits effectively. Many respondents indicated that simpler administration, stronger data and reporting capabilities, and more flexible enrollment support could improve the overall experience for brokers, employers, and employees.

3. Education and Understanding Gaps Persist: About 63% of brokers said improved employee education tools could increase adoption and effectiveness of supplemental health benefits. Only 33% of brokers believe employers understand supplemental offerings “very well,” highlighting ongoing knowledge gaps compared with core benefits such as medical coverage. The report also found differing perspectives on benefits’ impact, with employers more likely than brokers to cite improved morale and satisfaction as a key reason to offer benefits (85% vs. 48%), suggesting opportunities for clearer communication and alignment.

What’s the state of healthcare AI regulation?

By Maia Anderson – AI is rapidly becoming a standard part of the healthcare industry, from ambient scribes that help healthcare workers chart patient data to algorithms that can predict disease. Yet the regulatory environment surrounding health AI is still the Wild West. “The vast majority of medical AI is never reviewed by a federal regulator—and probably no state regulator,” I. Glenn Cohen, a law professor and faculty director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard University, told the Harvard Gazette in January. Read Full Article...

HVBA Article Summary

1. Health AI Regulation Faces Pace Challenges: Experts say regulating healthcare AI is difficult because the technology evolves much faster than traditional healthcare regulatory processes. Despite the rapid development of AI tools, most federal action has been limited, and Congress has not yet passed legislation directly regulating health AI. Survey data from Morning Brew Inc. indicates that 83% of 277 healthcare workers believe stronger regulation of AI in healthcare is needed.

2. States Lead Health AI Legislative Efforts: In the absence of federal legislation, state governments have taken the lead in developing health AI regulations. In 2025, 47 states introduced more than 250 AI-related healthcare bills, with 33 laws enacted across 21 states, addressing areas such as chatbot transparency, patient safety, and limits on AI-driven clinical decisions. Proposed legislation in 2026 continues to focus on mental health chatbots, patient disclosure and consent, preventing AI tools from presenting as clinicians, and regulating insurer use of AI.

3. Healthcare Industry Seeks Clear and Consistent Standards: Federal agencies such as the FDA and CMS have issued guidance and frameworks for evaluating and implementing AI in healthcare, though questions remain about how adaptive AI technologies will be regulated under existing medical device frameworks. Industry stakeholders note that clearer regulations could support innovation by providing predictable rules for development and deployment. However, health system leaders and technology companies warn that inconsistent state-level regulations could create fragmented standards that complicate nationwide adoption of AI tools.

Novo Nordisk’s FDA-Approved GLP-1s Now Available With Hims & Hers

By Him & Hers Health, Inc. – Hims & Hers Health, Inc. (NYSE: HIMS) [yesterday] announced that a broad assortment of Novo Nordisk’s FDA-approved GLP-1 medications are available to eligible customers, including the Wegovy® pill, which is the only FDA-approved GLP-1 weight loss pill.1 As a part of a collaboration with Novo Nordisk, Hims & Hers is making it simpler for customers to access FDA-approved GLP-1 medications which are now available at more affordable prices, with more doses and delivery methods. This expansion makes Hims & Hers the largest global consumer health platform for affordable access to approved medications. View Full Announcement...

HVBA Article Summary

1. Expanded Access to GLP-1 Medications: Hims & Hers has partnered with Novo Nordisk to offer a wide range of FDA-approved GLP-1 medications, including both injectable and oral options, to eligible customers. This collaboration aims to simplify the process for individuals seeking weight loss treatments and diabetes management. The availability of more delivery methods and dose options is intended to make these medications more accessible and affordable.

2. Comprehensive Weight Loss Support: Alongside the medication offerings, Hims & Hers is introducing a new membership program that provides additional support services for weight loss. Members will have access to 24/7 provider support, personalized nutrition guidance, ongoing clinical check-ins, and peer support through the Hers Weight Loss community. The membership is designed to offer a holistic approach to weight management, with medication costs billed separately and potentially eligible for HSA or FSA coverage.

3. Clinical Oversight and Future Offerings: Access to these medications will be determined by independent healthcare providers based on clinical appropriateness for each customer. For those whose needs are not met by commercially available FDA-approved GLP-1s, the company plans to offer compounded GLP-1s if deemed necessary by a provider. This approach underscores a commitment to individualized care and anticipates future expansion of treatment options as the field evolves.

Employees are living with cancer but their benefits are failing them

By Paola Peralta – Cancer touches millions of employees and their families each year, yet the benefits meant to support them often fall short of the realities of diagnosis, treatment and recovery. Seventy-four percent of employers report a rising prevalence of cancer within their workforce, according to data from the World Health Organization, a statistic that doesn't show any sign of slowing down with global cancer cases projected to rise 77% by 2050. It's becoming critical for leaders to design comprehensive, inclusive benefits that address the full spectrum of cancer care needs, from treatment access to caregiving and financial support. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Cancer Stigma and Uneven Treatment Access: Cancer diagnoses can carry significant stigma, which can create emotional and social challenges for patients in addition to medical concerns. While many employees have health insurance through their employers, not all plans cover advanced treatments such as stem cell transplants, CAR T-cell therapy, or newer immunotherapies. Limited coverage and availability at specialized cancer centers can lead some patients to face substantial out-of-pocket costs to access these therapies.

2. Gaps in Financial Support Beyond Medical Care: Health insurance often focuses on direct medical treatment but may not cover related costs such as housing or temporary lodging during treatment. Patients who must travel long distances to specialized facilities may struggle to afford accommodations while maintaining their regular living expenses. These additional financial pressures can compound the burden of cancer care and create further challenges for patients and their families.

3. Insufficient Leave Benefits and Need for Workplace Support: Many employees and caregivers face limited sick leave or caregiving leave while managing cancer treatment or supporting a loved one. As a result, some individuals are forced to take unpaid time off or leave their jobs due to treatment demands or caregiving responsibilities. Experts suggest that improving education around cancer benefits, expanding workplace resources, and partnering with support organizations could help employers provide more comprehensive assistance.