CMS Targeting Georgia, Ohio in Fraud Fight
The U.S. Centers for Medicare & Medicaid Services (CMS) has broadened its provisional enhanced‑oversight program, originally applied to California, Arizona, Nevada and Texas, to include Georgia and Ohio retroactive to Dec. 31, 2025. Both states are experiencing a surge of new hospice operators—Ohio’s Montgomery County now hosts 45 providers versus six a decade ago, while Georgia reports over 300 hospices, including 76 in Fulton County. The expanded oversight targets newly established facilities and ownership changes, imposing pre‑payment claim reviews and penalties ranging from claim denials to Medicare exclusion. Established nonprofit hospices largely welcome the added scrutiny, though rural providers worry about collateral impact.
Proposed Community-Based Palliative Care Model Aims to Expand Access to Care
The National Partnership for Healthcare and Hospice Innovation (NPHI) and the Coalition to Transform Advance Care (C‑TAC) are developing a federal fee‑for‑service, community‑based palliative care model that would deliver services earlier in a patient’s serious‑illness trajectory. The proposal focuses on...
Cotiviti VP: Patients Need Education to Combat Hospice Fraud
Cotiviti’s fraud‑prevention VP Erin Rutzler warns that patient and family education is a missing piece in the fight against hospice fraud. She notes that fraud not only drains Medicare, Medicaid and commercial payer funds but also harms honest providers by...
The American Diabetes Association Honors Senator Scott Wiener with a Lifetime Achievement Award
The American Diabetes Association presented Senator Scott Wiener with its Lifetime Achievement Award, recognizing his long‑standing advocacy for people with diabetes. Wiener’s leadership helped pass California Senate Bill 40, which caps insulin cost‑sharing at $35 per month for state‑regulated health...
Sun Pharma Q4 Net Profit up 26 per Cent
Sun Pharmaceutical Industries posted a 26.2% jump in Q4 net profit to roughly ₹2,714 crore ($327 million) and a 13.6% rise in sales to ₹14,559 crore ($1.75 billion). R&D spending reached 6.7% of sales, amounting to about ₹975 crore ($117 million) for the quarter. The company’s...
15 Trends From UnitedHealthcare
UnitedHealthcare’s 2026 Health Trends Report, based on claims from Nov 2024‑Oct 2025, shows a sharp rise in high‑cost medical expenses. Catastrophic claims over $100,000 grew 12.9%, while specialty drugs, though used in less than 2% of prescriptions, accounted for roughly 55% of...
Wolters Kluwer Launches Clinical AI Framework to Audit Bedside AI for Hospital Governance Committees
Wolters Kluwer Health unveiled a Clinical AI Validation Framework to help hospital governance committees audit generative AI tools at the bedside. The model assesses three dimensions—clinical intent, knowledge integrity, and clinical impact—moving beyond simple benchmark tests. In stress testing, its...
NIH Researchers Identify Avenue for Enhanced GLP-1-Induced Weight Loss
NIH scientists have mapped how the GLP‑1 agonist semaglutide triggers intracellular signaling in mouse hindbrain neurons, pinpointing cyclic AMP (cAMP) elevation in the area postrema as a key driver of weight loss. The study revealed that cAMP responses differ across...
Focus on Biosimilar Adoption: Driving Uptake Through Strategy
Teva’s U.S. Value & Access team has moved beyond simple payer formulary placement, adopting a holistic ecosystem approach that coordinates payers, providers, pharmacies, and health systems to accelerate biosimilar uptake. By redesigning contracts to include step‑therapy, lower patient cost‑sharing, and...
HIMSSCast: Scaling a Profitable Company with Little Venture Funding
Wisp, a women‑focused telehealth provider, has built a scalable business while raising less than $2 million in primary capital. CEO Monica Cepak highlighted the company’s cash‑pay model, which bypasses traditional insurance reimbursement and drives profitability. She urged founders to scrutinize capital‑raising...
When Rural Maternity Care Fails: Why Bipartisan Policy Must Stabilize Obstetric Infrastructure
More than one‑third of U.S. counties are now classified as maternity‑care deserts, contributing to a national maternal mortality rate of 18.6 deaths per 100,000 live births and 50.3 for Black women. Rural hospitals struggle to keep labor‑and‑delivery units open because...
MicroLED Implant Could Cast New Light on Cancer Treatment
Engineers and cancer scientists at the University of Glasgow have created a flexible, disc‑shaped implant that houses wirelessly powered microLEDs to enhance photodynamic therapy for bladder cancer. The 40 mm device can deliver optical power exceeding five milliwatts and penetrate synthetic...
Reduced Health Insurance Payments for Hospital Births Had a Bigger Impact on Sterilization Rates than Correcting an Injustice
A new study shows that a 1990s policy that reduced hospital payments for postpartum stays cut the length of birth hospitalizations, which in turn lowered the number of women receiving tubal ligations. By contrast, the 1974 Relf v. Weinberger case...
Australia Is Battling Its Largest Diphtheria Outbreak in Living Memory
Australia is experiencing its largest diphtheria outbreak since the 1930s, with 230 confirmed cases and one adult death reported in 2026. The surge is concentrated in remote Indigenous communities across the Northern Territory and Western Australia, following an imported case...
Ebola Outbreak Prompts Scrutiny of Trump Cuts
The Trump administration’s deep cuts to USAID’s global health budget and its withdrawal from the World Health Organization are being blamed for a delayed response to the Ebola outbreak in the Democratic Republic of Congo and Uganda. Funding for U.S....