Business Intelligence

Providers utilize business intelligence to monitor referral patterns and collaborate with clinicians who order their services. Such analytics tools have also been deployed in the specialty to improve productivity, track patient satisfaction and bolster quality.

Elevance pays CMS $342M to assuage concerns of noncompliance and overbilling
The Medicare Advantage insurer said the payout is equal to what a CMS audit stated was the total amount the company was overpaid for patient care services. Despite receiving the cash, the agency has yet to officially withdraw its enforcement action, as the two parties are still negotiating.
Top GLP-1 prescription indications include sleep apnea, depression and kidney disease, study finds
A report from Trilliant Health looking at payer data found that, as prescriptions for the popular weight loss drugs spike, so rises the number of approved benefits.
Florida probes CVS Health in latest crackdown on PBMs
State Attorney General James Uthmeier is forcing the company to hand over thousands of documents related to its pharmacy contracts and reimbursement policies to see if the retail giant is abusing its position in the market as both a pharmacy benefit manager and a retail chain of drug stores.
Private equity unlikely to dominate cardiology despite hype
Medaxiom CEO Jerry Blackwell, MD, MBA, FACC, discusses investor's interest in buying cardiology practices, noting that PE ownership remains relatively low.
OIG warns of ‘ghost network’ trouble in maternal health managed care
Looking at the three largest Medicaid managed care plans related to maternal health, the Office of Inspector General found instances of ineligible providers being included in directories, as well as other errors such as incorrect contact information.

UnitedHealth agrees to $1.8M settlement over robocall complaint

The unwanted spam calls were associated with Optum's home healthcare service. Plaintiffs alleged they received the marketing calls despite opting out and never signing up, in violation of federal consumer protection laws. The company does not admit to wrongdoing.

artificial intelligence pharmaceutical industry

Rite Aid closing distribution center and 68 stores

A week after filing Chapter 11 bankruptcy, the liquidation of Rite Aid's remaining assets has begun.

Amazon One Medical employees viewed health data of man in wrongful death case

One Medical, a chain of primary care clinics owned by Amazon, is being sued by the family of a man who died due to alleged provider negligence. Now, court filings reveal staff improperly accessed the deceased man's protected medical records.

UnitedHealth CEO resigns 'effective immediately' as board chair takes over

Andrew Witty is stepping down as CEO of UnitedHealth Group, citing "personal reasons." Former CEO Stephen J. Hemsley has taken over, the company announced Tuesday.

CVS Health sued by coalition of states alleging Medicaid fraud by pharmacies

A whistleblower lawsuit claims CVS pharmacies have overbilled state Medicaid programs for prescription drugs—a practice allegedly ongoing since 2016. The company denies any wrongdoing.

Optum UnitedHealthcare UnitedHealth Group HQ

UnitedHealth, Amedisys offer divestitures as $3.3B merger advances

Pennant and BrightSpring Health Services have agreed to purchase some healthcare businesses from UnitedHealth and Amedisys. However, it remains unclear whether this will be enough for the DOJ to drop its lawsuit blocking the merger.

Healthcare AI newswatch: FDA’s AI gambit, FDA’s blind spot, everybody’s agentic AI, more

The FDA is getting AI-aggressive about speeding up device reviews. Its plan is to unleash generative AI on tedious and repetitive tasks.

Video of how capital investments firms are partnering with hospitals.

Private equity firm Deerfield earmarks $600M for healthcare investments

Deerfield Management released details on its latest Healthcare Innovations Fund program, promising to finance “promising therapeutics” and “elevating emerging technologies," including artificial intelligence.

Business Intelligence

Elevance pays CMS $342M to assuage concerns of noncompliance and overbilling

Top GLP-1 prescription indications include sleep apnea, depression and kidney disease, study finds

Florida probes CVS Health in latest crackdown on PBMs

Private equity unlikely to dominate cardiology despite hype

OIG warns of ‘ghost network’ trouble in maternal health managed care