Investors Need An Apology, CMS Crackdown, 30 Year Old 340B Overcharge Gets Refunded

Hey all,

Happy hump day! I cheered as I read about CMS’ hiring of 2,000 auditors. I am excited how Dr. Oz is empowering the agency to fight rampant malfeasance by Medicare Advantage insurers. Enjoy the rundown! 

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Becker's Hospital Review) UnitedHealth CEO Acknowledges Missteps and Outlines Recovery Plan

New UnitedHealth CEO Stephen Hemsley admitted to investors on June 2 that the company has fallen short of expectations and pledged to rebuild trust through greater transparency, better pricing strategies, and operational improvements at Optum Health and UnitedHealthcare. The acknowledgment comes amid rising care utilization costs, shareholder scrutiny over executive compensation, DOJ investigations into Medicare Advantage billing practices, and ongoing concerns about AI's role in coverage decisions. And don’t worry—he didn’t waste an apology on patients; just the investors, the real VIPs in healthcare. Full Article

(HEALTH CARE un-covered) CMS Audit Crackdown on UnitedHealth

The Centers for Medicare and Medicaid Services (CMS) has launched a sweeping expansion of its audit program targeting Medicare Advantage (MA) plans, potentially uncovering tens of billions in overpayments and further destabilizing UnitedHealth’s already troubled year. With nearly 2,000 auditors being hired to scrutinize all MA insurers—up from just 40—this move marks a major shift in regulatory enforcement against what advocates have long criticized as systemic overbilling by private insurers. For UnitedHealth, already under criminal investigation and facing stock and investor turmoil, the audits could mark a major turning point. Fittingly, no one seems too upset that UnitedHealth will now have to endure a bureaucratic nightmare as painful and drawn-out as the prior authorizations they’ve inflicted on patients and providers for years. Full Article.

(340B Report) 340B Methadose Refunds

SpecGx, a subsidiary of Mallinckrodt Pharmaceuticals, will issue refunds to 340B covered entities for overcharges on Methadose dating back to 1992, marking a record-setting 32-year refund period. The move, prompted by revised Medicaid pricing data and announced via the HRSA Office of Pharmacy Affairs, reflects mounting accountability pressures on opioid manufacturers amid ongoing bankruptcy and merger proceedings. More evidence that 340B is messed up is that it only took new pricing data from HRSA to find decades old overcharges to be discovered.  Full Article.