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.

Optum UnitedHealthcare UnitedHealth Group HQ

UnitedHealth, Amedisys ask federal judge to dismiss DOJ lawsuit blocking $3.3B merger

The companies argue that the U.S. Department of Justice has failed to adequately demonstrate how, and in which regions of the country, the merger would harm competition. They are asking a federal court to throw out the case.

UnitedHealth shareholders push company to report on impact of claims denials

The motion is being advanced by religious groups and hedge funds alike, with the decision to develop a report set to be voted on at the UnitedHealth Group 2025 annual meeting.

Healthcare private equity reporting act signed into law by Mass. governor

The new law will require private equity firms to make disclosures related to organizational structure and finances if they intend to operate a medical facility or provider organization in the state.

Industry Watcher’s Digest

Is AI adoption a marathon or a sprint?

Healthcare systems set up at the ACC.24 career fair in hopes of filling open positions, including a large and growing number of general cardiologist positions. Photo by Dave Fornell #ACC24 #ACC2024

Healthcare, AI top list of fastest growing jobs

While artificial intelligence engineers and consultants took the top two spots, physical therapists and advanced practice providers also landed among the 25 fastest growing jobs in the U.S.

$49B in medical debt to be erased from credit reports

A new final rule from the Consumer Financial Protection Bureau bans reporting agencies from including medical debts on credit reports or factoring them into credit scores.

$3.3B merger of UnitedHealth and Amedisys delayed by DOJ lawsuit

The new deadline for the deal to be finalized is Dec. 31, 2025. However, the ultimate fate of UnitedHealth's acquisition of Amedisys will be decided in a federal court.

artificial intelligence AI infrastructure

Industry Watcher’s Digest

New Year’s Day brought the go-live for California’s new law forbidding the use of AI to deny health insurance claims.

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