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.

Medicare Advantage insurer accused of upcoding by a whistleblower settles False Claims Act lawsuit for $22.5M
Independence Blue Cross, the largest medical insurance provider in the Philadelphia area, does not admit to wrongdoing. It was accused in a lawsuit backed by the U.S. Department of Justice of misrepresenting the severity of patient illnesses to juice risk-adjusted Medicare payments.
Housing AI company hits $4B valuation as it expands into healthcare
With its $350M in new funding, EliseAI said it plans to build out its technology and sales force. It currently works with specialty provider groups to automate practice operations such as scheduling and insurance verification.
Rural cardiology practices struggle to fill vacancies
A new survey put a spotlight on the staffing issues rural cardiology practices and health systems face on a daily basis.
Some physicians not only avoid burnout but also find fulfillment. Here’s how they do it.
Of surveyed and interviewed U.S. physicians who showed significant six-month improvement in follow-up vs. baseline wellness checks, 47% attributed the gain to active personal changes. Not far behind were those who credited active work-related changes—40% of the field.
Mayo Clinic, Thermo Fisher Scientific launch new AI-supported diagnostics company
The new entity, Precure, will be owned by both groups. Its work in detecting early disease for timely intervention stems from a research project launched this summer. The Mayo Clinic said Precure will make the results of that initiative actionable.

Medaxiom CEO Jerry Blackwell, MD, explains the role of private equity in cardiology and that it is a small player in cardiology practice ownership.

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.

OhioHealth agrees to void contracts that allegedly punished payers for including competitors in-network

The U.S. Department of Justice said the settlement will save citizens of the state money and open up the market to competition.

Major private payer encouraging employees to leave willingly

The largest Medicaid-specialized managed care organization in the U.S. is offering buyout packages to most of its 60,000 or so staff workers.

‘Epic’ trademark lawsuit leaves healthcare staffing firm without a name

Epic Systems, the market leading EHR vendor, sued California-based Epic Staffing in 2024, arguing that the company’s name created confusion in the market. The lawsuit was settled out of court, with the employment firm agreeing to a full rebrand.

As Americans tuck into supplements like their health depends on it, specialized products are displacing multivitamins

Some of today’s most popular products promise better immune, adaptogenic, anti-inflammatory, gut, skin or joint health—or combinations of two or more of the above.

Express Scripts sues Tennessee over PBM law that would close specialty pharmacy

The company called the state’s regulation of pharmacy benefit managers “shortsighted,” as it would force the closure of Accredo, a specialty drug dispensary that supplies drugs it says aren’t available anywhere else in the state.

Optum UnitedHealthcare UnitedHealth Group HQ

FTC settles lawsuit with Optum Rx, ending its campaign against the ‘big three’ PBMs

The agency had been suing the three largest pharmacy benefit managers over their alleged control of insulin prices. It reached agreements with CVS’ Caremark and Cigna’s Express Scripts earlier this year.

Business Intelligence

Medicare Advantage insurer accused of upcoding by a whistleblower settles False Claims Act lawsuit for $22.5M

Housing AI company hits $4B valuation as it expands into healthcare

Rural cardiology practices struggle to fill vacancies

Some physicians not only avoid burnout but also find fulfillment. Here’s how they do it.

Mayo Clinic, Thermo Fisher Scientific launch new AI-supported diagnostics company