Complete Health to pay $14M to settle Medicare Advantage fraud allegations
The value-based primary care provider submitted false diagnosis codes to the CMS for three years, inflating its reimbursement by millions of dollars, according to the DOJ.
Sentara moves to end Anthem contracts in Virginia
Nearly 380,000 patients could go out of network with the health system if the commercial, Medicare and Medicaid contracts lapse.
HCA nabs 40 urgent care clinics in Texas acquisition
The hospital juggernaut is adding Texas MedClinic’s locations to its nationwide portfolio of urgent care clinics amid rising consumer demand for fast and convenient medical attention.
Hackensack Meridian Health first to earn Joint Commission’s responsible health AI certification
Private consortiums have been attempting to put guardrails around the use of AI as federal regulations lag. HMH has been refining its AI governance structure for years, its medical informatics chief said.
Medicare finalizes 2.3% hospital inpatient pay raise for 2027
Regulators also finalized the first nationwide, mandatory payment model to reduce the cost of joint replacements starting in 2028. Hospitals said the pay raise was inadequate, and chafed at the mandatory nature of the new model.
Hospitals say they’re feeling the pinch as more patients lose insurance
Half a year after major cuts to the Affordable Care Act exchanges went into effect, hospitals say more patients are going uninsured. That’s starting to drag their finances, for-profit hospitals say.
The unexpected upsides of vaccines
The COVID-19 pandemic heightened vaccine skepticism. Six years later, CVS’ chief medical officer talks about building trust with patients — and the surprising benefits of many vaccines.
Consider strategy over rushed implementation: Readying healthcare organizations for AI transformation
Healthcare leaders must modernize their digital foundations to scale AI investments for long-term success.
Out-of-Network claims are costing you more than you think
88% of IDR disputes go to providers. See how health plans can fix OON claims first.
Every extra review cycle is a cost center; RAAPID OnePass removes the need
Why layered review cycles drain budgets and how OnePass delivers audit-ready coding in one review.