Medicare & Medicaid
CMS will negotiate outcomes-based agreements with CGT manufacturers on behalf of state Medicaid agencies.
CMS says it also wants to calculate more accurate payment rates for certain services.
PBM provision, silver loading left out of final version of One Big Beautiful Bill Act due to Byrd Rule.
DOJ’s criminal healthcare-fraud unit is investigating how UnitedHealth deployed doctors and nurses to gather diagnoses that bolstered its payments, WSJ says.
AHA: "The number of individuals who will lose health coverage - cannot be simply dismissed as waste, fraud, and abuse."
Defendants include 96 doctors, nurse practitioners, pharmacists and other licensed medical professionals.
Defendants include 96 doctors, nurse practitioners, pharmacists and other licensed medical professionals.
About 103,000 beneficiaries may have been impacted by the creation of fraudulent Medicare.gov accounts.
Dr. Sophia Toya prescribed thousands of orthotic braces that were not medically necessary, DOJ says.
The model will leverage AI and machine learning for prior authorization of services vulnerable to fraud or inappropriate use, CMS says.