Last summer, I wrote about the DOJ and HHS relaunching their joint False Claims Act Working Group, with Medicare Advantage risk adjustment fraud listed as one of its top enforcement priorities. The Aetna settlement announced earlier this month is a direct example of that initiative delivering results.
Aetna has agreed to pay $117.7
Artificial Intelligence continues to move quickly into the clinical workflow.
WVU Medicine recently announced that it is expanding its use of Abridge, an AI-powered transcription platform designed to generate clinical documentation during patient encounters. What began as a small pilot program in 2025 has now grown to more than 1,200 physicians, nurse practitioners, and physician
The Centers for Medicare & Medicaid Services (CMS) recently announced a new payment initiative that will require certain cardiologists to participate in a value-based reimbursement model focused on heart failure care. This program, known as the Ambulatory Specialty Model (ASM), is scheduled to begin January 1, 2027 and will run through December 31, 2031.
The
The Trump administration announced a new $50 billion rural health transformation program that will send between $147 million and $281 million to each state beginning in 2026. The funding, administered through Centers for Medicare & Medicaid Services, is designed to improve rural health outcomes by restructuring care delivery. States will be required to meet specific
Since the last update regarding non-compete agreements in healthcare, there have been recent developments over the past few weeks, both in the courts and with the Federal Trade Commission (FTC), that have brought some clarity on restrictive covenants for healthcare professionals. At the federal level, the FTC is ramping up case-by-case enforcement, with a focus
As of October 1st, the federal government is officially shut down after Congress failed to pass funding legislation. While the biggest direct impact will certainly be on furloughed federal workers and government agencies, if your practice relies on Medicare or Medicaid, or you are involved in research, there are ripple effects worth understanding.
The U.S. Department of Health & Human Services (HHS) issued a Final Rule in April 2024 amending the HIPAA Privacy Rule to strengthen protections for reproductive health care information. The goal was to prevent medical records from being used to investigate or penalize patients or providers for seeking or offering lawful reproductive care.
However, in
Most physicians put significant thought and effort into reviewing and negotiating their employment contracts before signing. But what happens when you’ve started your new position, and now you’re noticing red flags: the call schedule is heavier than promised, your bonus formula doesn’t match what you understood, or the support staff and resources you were promised
On July 14, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the 2026 Physician Fee Schedule. As expected, there are several meaningful updates that providers, practices, and health systems should be aware of.
One of the more significant changes is that CMS will split the conversion factor into two separate
The U.S. Department of Health and Human Services (HHS) and the Department of Justice (DOJ) have jointly announced the launch of a reinvigorated DOJ-HHS False Claims Act Working Group aimed at enhancing interagency coordination around key fraud enforcement priorities in the healthcare space. This initiative underscores the federal government’s ongoing reliance on the False Claims