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June 25, 2024

Security Group Rates Healthcare Cyber Readiness SecurityScorecard gave healthcare a “B+” in cybersecurity, but some healthcare organizations had low ratings despite the group concluding that ratings were “higher than expected.” I tend to think that ratings are a bit inflated, but nonetheless it is a good service for the nation. #cyberattacks #healthcare https://www.fiercehealthcare.com/health-tech/report-90-healthcare-orgs-get-b-cybersecurity-medical-devices-fall-below-mark Bipartisan Group Of Lawmakers Wants Greater MA Restrictions On AI Use A bipartisan group of senators and representatives are back at it, touting the agenda of provider lobbies.  The group sent a letter to the Centers for Medicare and Medicaid Services (CMS) asking the agency to rein in the use of AI in prior authorizations and to potentially suspend the use of internal criteria until such time CMS rules can be written. Additional articles: https://www.modernhealthcare.com/politics-policy/medicare-advantage-ai-restrictions-prior-authorization and https://insidehealthpolicy.com/daily-news/congress-cms-step-oversight-ai-algorithms-ma-prior-authorization and https://www.beckerspayer.com/policy-updates/tougher-rules-needed-for-medicare-advantage-ai-51-lawmakers-say.html and https://thehill.com/policy/healthcare/4739152-bipartisan-lawmakers-increased-ai-oversight-medicare-advantage-coverage/ (Some articles may require a subscription.) #ai #medicareadvantage #priorauthorization https://www.statnews.com/2024/06/25/medicare-advantage-ai-tools-denial-unitedhealth-lawmawkers-cms/ Analysis Of ACA Preventive Services Lawsuit

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June 24, 2024

Supreme Court Declines To Hear BCBS Antitrust Case The Supreme Court declined to hear a case challenging the anti-trust settlement between the federal government and BCBS plans nationwide.  While no wrongdoing was admitted, BCBS plans were accused of anti-competitive behavior in the employer market because it limited employers to contracting with BCBS entities in their headquarters’ area and required a threshold for Blues revenue. The appeals court argued the settlement does not preclude future actions. The high court agreed. Several employers argued the settlement was not enough and that it did preclude certain actions over time. I will be writing about this soon. While the settlement was somewhat of a defeat for the Blues and its association, it actually tends to underscore the anti-competitive aspects of the broader healthcare market and protects the Blues. Additional articles: https://www.modernhealthcare.com/legal/supreme-court-bcbs-settlement-home-depot and https://www.beckerspayer.com/payer/supreme-court-rejects-home-depots-challenge-to-2-7b-bcbs-settlement.html (Some articles may require a subscription.) #bcbsa #blues #healthcare #coverage #employercoverage

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