DOJ is increasing enforcement on Medicare Advantage upcoding as recent settlements reveal widespread issues with unsupported diagnoses and inflated payments.
Grand jury says $10m from a Medicaid settlement was improperly diverted to Hope Florida, raising concerns about oversight and use of public funds.
The agency says machine-learning and AI analytics contributed to increased enforcement.
Our in-brief roundup of notable healthcare and life sciences stories from the last two weeks.
The American Hospital Association warns against accelerating clawbacks and reducing reimbursements under CMS’s 2027 OPPS rule.
Warehouse giant partners with Scan Health Plan to offer Medicare Advantage and supplemental plans, extending its growing footprint in low‑cost healthcare services.
The US DOJ memo outlines fraud enforcement priorities, spotlighting healthcare, tax, trade, and corporate misconduct.
The 5th Circuit struck down parts of the No Surprises Act’s QPA calculation while upholding federal limits on air ambulance payment challenges.
