Weighed Down by Alleged Fraud, CVS’s Omnicare Files for Bankruptcy

By Wendell Potter – CVS’s subsidiary Omnicare has collapsed under the weight of its own alleged misconduct. Earlier this week, the long-term care pharmacy filed for Chapter 11 bankruptcy protection after being ordered to pay nearly $1 billion in penalties for filling prescriptions that were expired or out of refills, then billing Medicare and Medicaid as if nothing was wrong. Read Full Article...

HVBA Article Summary

1. Omnicare’s Legal and Financial Troubles: The U.S. Department of Justice concluded that Omnicare, a pharmacy services provider owned by CVS, had been dispensing medications based on “stale, invalid prescriptions” between 2010 and 2018. These prescriptions were primarily for elderly patients in nursing homes, involving serious medications for conditions like heart disease and dementia. The resulting $949 million court judgment became Omnicare’s largest unsecured debt, ultimately driving the company into bankruptcy and creating significant financial exposure for CVS.

2. Recurring Legal Issues and Corporate Impact: This is not the first legal challenge for Omnicare. Prior settlements in 2014 and 2016 over similar allegations resulted in payouts of $124 million and $28 million, respectively. The latest judgment, however, proved far more damaging and marks a turning point for CVS’s troubled investment in the company. What was once seen as a strategic acquisition turned into a major liability, underlining the dangers of aggressive expansion without sufficient oversight and compliance.

3. Wider Concerns About Health Industry Consolidation: The article also places CVS’s challenges within the broader trend of consolidation in the healthcare industry, comparing it to UnitedHealth Group’s complex and sprawling structure. Industry experts and analysts, including Steve Eisman and Michael Ha, suggest that these conglomerates may have become so large and fragmented that internal mismanagement is increasingly likely. CVS’s experience with Omnicare serves as a cautionary example of the risks inherent in unchecked vertical integration.

U.S. lacks way to measure physician consolidation

By Allison Bell – Analysts who want to measure the impact of U.S. physician practice consolidation on the cost, supply and quality of care need a better way to tell which physicians are consolidated. Leslie Gordon, a director at the U.S. Government Accountability Office, gave that assessment earlier this week in a report summarizing a GAO analysis of physician consolidation. The GAO defined "physician consolidation" to mean situations in which a physician works for a private equity firm, a hospital, an insurance company or some other entity other than an organization owned and managed by physicians. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Lack of Unified Data Source for Physician Consolidation: The Government Accountability Office (GAO) report highlights a significant issue: there is no single, public data source that accurately identifies which physicians are part of consolidated practices and which remain independent. This lack of standardized data complicates efforts to study and understand the effects of physician consolidation on the healthcare system. Without this clarity, analyses of cost, quality, and access are hampered by inconsistent methods and incomplete information.

2. Challenges in Measuring Consolidation’s Impact: The GAO found that although some studies suggest that consolidation with hospitals and private equity firms may increase healthcare costs, there is insufficient information about the effects of insurer acquisitions or consolidation on patient access to care. The difficulty tracking physician employment and ownership status means gaps remain in understanding how practice consolidation influences healthcare delivery, pricing, and quality outcomes nationwide.

3. Policy and Stakeholder Concerns: Employers, benefits advisors, and policymakers worry that increased health care provider consolidation is driving up health plan claim costs and potentially affecting patient outcomes. These concerns have prompted states to draft regulations aimed at slowing consolidation and increasing oversight, while U.S. senators have questioned the impact of consolidation on patient health. Despite these efforts, the federal government currently lacks a straightforward mechanism to categorize physician practices as consolidated or independent, limiting regulatory and research effectiveness.

US to impose 100% tariff on branded, patented drugs unless firms build plants locally, Trump says

By Lim Hui Jie and Annika Kim Constantino – President Donald Trump announced Thursday that the U.S. will impose a 100% tariff on "any branded or patented Pharmaceutical Product" entering the country from Oct. 1. The measure will not apply to companies building drug manufacturing plants in the U.S., Trump said. He added that the exemption covers projects where construction has started, including sites that have broken ground or are under construction. "There will, therefore, be no Tariff on these Pharmaceutical Products if construction has started," Trump said in a post on Truth Social. Read Full Article...

HVBA Article Summary

1. Implementation of Tariffs and Exemptions: Starting October 1, the U.S. will impose a 100% tariff on all branded or patented pharmaceutical products imported into the country, unless companies construct drug manufacturing facilities domestically. The tariff exemption applies to projects where construction has commenced, including sites that have already broken ground or are under construction. This policy aims to encourage pharmaceutical companies to reshore manufacturing activities to the United States to bolster domestic production capabilities.

2. Potential Impact on Drug Supply Chain and Industry Response: The tariffs have raised concerns among pharmaceutical companies and health policy experts regarding potential disruptions to the drug supply chain, increased drug costs, and negative effects on investments in research and production in the U.S. Companies argue that the tariffs may divert capital needed for innovation and reshoring initiatives, while experts worry about medication shortages and higher prescription drug prices amidst efforts to lower healthcare costs.

3. Challenges and Industry Adaptations: Analysts highlight the complexity and costs associated with relocating pharmaceutical manufacturing to the U.S., noting that such reshore efforts may not occur swiftly or extensively due to existing global supply chain structures. Some companies like Johnson & Johnson and Eli Lilly have invested significantly in U.S.-based manufacturing and may be better positioned to manage the tariffs. However, other firms with fewer U.S. manufacturing sites face greater exposure to increased costs and supply chain risks.

AI's Paradoxical Gift to Primary Care

By R. Shawn Martin, MS – Primary care is the foundation of a well-functioning healthcare system. It's where relationships are built, it's where we prevent disease, and it's where complex health needs are managed with skill and compassion. But the systemic support for primary care in the U.S. is under strain, and administrative tasks too often crowd out the most important work: connecting with patients. That's exactly why primary care deserves more than the bare minimum it has received over many years. It deserves the resources and tools that allow it to thrive. Enter artificial intelligence (AI). Read Full Article...

HVBA Article Summary

1. AI's Potential to Reduce Administrative Burden: AI technology offers a promising solution to alleviate the administrative and cognitive workload that burdens primary care physicians. Tools such as AI-generated clinical notes and data analysis can save significant time, allowing clinicians to focus more on patient care rather than paperwork. This shift could lead to more meaningful patient interactions and improved preventive care outcomes.

2. Challenges and Risks of AI Integration: Despite its potential benefits, AI adoption in primary care faces challenges including concerns about accuracy, integration with existing electronic health records, and the creation of new workflows that may complicate rather than simplify tasks. Additionally, risks such as privacy breaches, bias, and unclear liability remain significant considerations that need to be addressed to ensure safe and effective use of AI in healthcare.

3. The Importance of Human-Centered AI Design: Primary care is inherently relational and holistic, requiring AI tools to support and enhance the physician-patient relationship rather than reduce it to data points. Successful AI implementation must involve clinicians in the design and deployment process to avoid exacerbating inequities or increasing burnout. When done correctly, AI can help preserve the human element of primary care while strengthening the system overall.

The Truth About Medical Debt and Credit Reporting: Three Things To Know

By Karie Bostwick – Medical debt is unfortunately synonymous with healthcare in the United States. Approximately 41% of Americans have debt for medical or dental bills – meaning they are currently owing a bill, being contacted by a collection agency or actively paying off past balances. Furthermore, an April 2024 report from the Consumer Federal Protection Bureau (CFPB) found that 15 million Americans had medical bills on their credit reports, accounting for a whopping $49 million worth of outstanding debt. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Federal medical debt reporting rules remain unchanged: The CFPB’s January 2025 rule to remove medical debt from credit reports never took effect after a July 2025 federal court ruling. Under the current federal standard, medical debts over $500 can still be reported if at least 365 days have passed since the first collection notice. While 15 states (including California, New York, and Delaware) provide additional consumer protections, and credit bureaus have policies such as removing paid medical collections and excluding debts under $500, at the federal level the Biden-era rule is effectively void.

2. Hospitals retain credit reporting as a financial tool: With 8–12% of hospital revenue tied to patient balances, credit reporting continues to serve as leverage to encourage timely payments and reduce bad debt. Hospitals are advised to use point-of-service collections, updated payment policies, financial counseling, and outsourced collection strategies. Given ongoing financial strain from reduced Medicare/Medicaid reimbursements, debt reporting helps hospitals secure resources to sustain operations and avoid deficits that could impact patient care.

3. Consumers maintain rights to dispute medical debt: Research shows that up to 80% of medical bills contain errors, contributing to over $125 billion annually in industry costs and reimbursement delays. Patients can dispute inaccurate balances and request audits, regardless of whether they live in a state with medical debt reporting bans. Importantly, while medical debt does appear on credit reports, lenders generally weigh other obligations—such as credit cards and installment loans—more heavily in risk assessments.

Small business health care premiums set to jump 11% next year

By Kristen Smithberg – Small businesses face health care premium increases of about 11% next year, as health care costs continue to rise, according to Peterson KFF’s Health System Tracker. The analysis is based on rate filings submitted to state regulators by health insurers outlining their expectations for the coming year and proposing premium changes for Affordable Care Act-compliant plans. The small group market covers plans offered to companies typically with less than 50 employees. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Range and Drivers of Premium Increases: Small group health insurers are proposing premium adjustments that vary widely, from a 5% decrease to a 32% increase. The majority of insurers are seeking increases in the 5% to 15% range, while around 10% are requesting increases above 20%. These proposals are largely attributed to rising health care costs, including higher expenses related to hospital stays, physician services, and prescription drugs. Insurers estimate that the underlying medical cost trend is growing at about 9% annually.

2. Economic and Structural Market Pressures: Broader economic conditions are also influencing premium hike proposals. Factors such as general inflation, ongoing labor shortages, and consolidation among healthcare providers are leading to higher reimbursement rates. Some insurers specifically mention that provider consolidation is reducing market efficiency, which further drives up costs. In addition, about one-quarter of insurers are factoring in potential tariff impacts—noting that higher tariffs could raise the price of pharmaceuticals and medical supplies.

3. Drug Trends and Market Volatility Impacting Costs: The increasing use, cost, and demand for GLP-1 medications and other specialty drugs are frequently cited as significant drivers of proposed rate hikes. To help offset premium pressures, some insurers are choosing to exclude GLP-1s when used for weight loss. Moreover, the small group insurance market is experiencing increased volatility due to declining enrollment—with some employers turning to self-funded or level-funded plan alternatives. These plans can offer lower costs, especially for employers with healthier-than-average workforces, and are not subject to certain state regulations or taxes, making them a more appealing option.

12 called-off hospital deals

By Alan Condon – Mergers, affiliations and long-standing clinical partnerships have become increasingly fragile amid evolving financial pressures, shifting strategic priorities and growing regulatory scrutiny. Over the past four years, several high-profile hospital deals have been terminated — some before agreements were finalized, others after decades of collaboration. Read Full Article...

HVBA Article Summary

1. Financial and Regulatory Pressures Impact Hospital Partnerships: Many hospital mergers, affiliations, and joint ventures have been called off or unwound recently due to increasing financial challenges and regulatory scrutiny. These pressures have caused health systems to reconsider or withdraw from previously planned collaborations, affecting both new deals and long-standing partnerships.

2. Diverse Reasons for Deal Terminations: The article lists 12 specific cases where hospital deals were terminated or partnerships ended, citing reasons such as financial challenges, shifts in organizational values, legislative uncertainty (e.g., the One Big Beautiful Bill Act), and strategic realignments. Some hospitals chose to remain independent, while others transferred ownership or operational control to different entities.

3. Impact on Healthcare Landscape and Patient Care: The dissolution of these partnerships and deals may lead to changes in hospital operations, ownership, and service delivery. For example, some hospitals will no longer operate as Catholic facilities, pediatric care services are shifting between providers, and some hospitals are exploring new partnerships to adapt to the evolving healthcare environment. These changes reflect the dynamic nature of healthcare systems responding to external and internal challenges.

A look at the limited employee benefits provisions of the One Big Beautiful Bill Act

By Daniel Lacomis – Although the original House of Representatives version provided for extensive health care changes and pharmacy benefit manager (PBM) reforms, the final of the One Big Beautiful Bill Act (OBBB) contains only a few provisions that affect employee benefit plans. Nonetheless, the OBBB offers a few useful options for benefit plan sponsors. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Permanent Telehealth Coverage Before Deductibles: The OBBB permanently allows HDHPs to cover telehealth services before the deductible is met, retroactive to January 1, 2024. This change ensures ongoing HSA eligibility and removes the previous expiration date of December 31, 2024. Employers may need to amend their HDHPs to offer first-dollar telehealth benefits.

2. HSA Eligibility Expanded for Direct Primary Care (DPC) Fees: Starting January 1, 2026, HDHP participants will be allowed to use HSA funds to pay for monthly DPC membership fees—limited to $150 per month for individuals and $300 for families (indexed for inflation post-2026). Employers should prepare to update their plans accordingly for the 2026 plan year.

3. New Savings and Benefit Enhancements for Families and Children: The dependent care FSA annual limit will increase to $7,500 (or $3,750 for separate filers) starting in 2026, though it will not adjust for inflation thereafter. Additionally, a new tax-advantaged savings account, informally known as the “Trump account,” will be available for children under 18, with features similar to IRAs and optional employer contributions up to $2,500 annually.