New & Notable
CMS fraud war room stops $203M in debated Medicaid payments
In less than 90 days, the new Medicaid Fraud War Room blocked payments to 50 unique providers at high-risk of defrauding the federal healthcare program, the CMS says.
OIG calls on states to tamp down Medicaid provider fraud
States must create more specific contracts with Medicaid MCOs detailing requirements for Medicaid provider fraud referrals, OIG advised.
CMS moves to codify limits on Medicaid provider taxes
The rule is meant to prevent states from guaranteeing that providers will be refunded for their tax costs, and should save Washington $246 billion over the next decade, regulators said.
— Healthcare Dive
Trump administration pauses $1B in Medicaid payments to California, Minnesota
Federal regulators are pausing more Medicaid funds to the states, citing suspicious payments and concerns about fraud.
— Healthcare DiveSponsored Sites
Healthcare Strategies: A Podcast
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A podcast for healthcare professionals seeking solutions to today's and tomorrow's top challenges. Hosted by the editors of Xtelligent Healthcare Media, this podcast series focuses on real-world use cases that are leading to tangible improvements in care quality, outcomes, and cost.
Guests from leading provider, payer, government, and other organizations share their approaches to transforming healthcare in a meaningful and lasting way.
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Latest News
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3.8M qualify for Medicare GLP-1 Bridge at program's July start
With 3.8M Medicare enrollees qualifying for the GLP-1 Bridge, the program could lay the groundwork for future payment models for the weight loss drugs.
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HHS cut 3M ACA Marketplace enrollments in ongoing fraud efforts
The agency said it rooted out fraudulent Affordable Care Act enrollments following the 2025 Trump rule that laid out stricter eligibility, enrollment and enforcement standards.
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ACA Marketplace premiums might see a double-digit spike in 2027
The early look at ACA Marketplace premiums shows that the tax credit lapse and rising medical cost trend could lead to high premium costs for consumers in 2027.
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As No Surprises Act rules tighten, Zelis expands AI role in dispute process
Zelis launches an AI-powered platform for No Surprises Act disputes as insurers face new compliance demands and scrutiny over reimbursement practices.
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RAND: State Medicaid funding to fall 5% or more for half of the U.S.
State Medicaid funds are slated to fall by $679B through 2034, with 26 states facing cuts of 5% or more, while a select few are expected to see a boost, RAND reports.
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OIG: Medicaid managed care provider directories have inaccuracies
Medicaid managed care plan provider directories contain inaccuracies about in-network maternity care providers and their contact information.
Features
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5 healthcare pros on the trends defining primary care
The 2025 Payer + Provider Virtual Summit explored AI, value-based care and community-based partnerships, offering strategies on how to promote primary and preventive care.
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How payers can regain consumer trust via personalized care
Creating personalized health plans is central to regaining consumer trust. To do that, payers must outline safeguards for member data and create seamless experiences.
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With trust low and costs high, do payers stand to lose members?
Healthcare payers might see fewer enrollments as members face higher prices for a product they don't trust or see as high value.
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Breaking down the ABCs of rising alternative health plans
More employers are seeking alternative health plans, like AHPs and ICHRAs, to bend the cost curve, but education is key to navigating their growing popularity.