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AdaptHealth says hackers exfiltrated patient data in social engineering attack
2+ mon, 5+ day ago (254+ words) Gulenok/istock via Getty AdaptHealth, a nationwide supplier of home medical equipment, disclosed a data...received a communication from a cyberthreat actor on June 15, 2026, claiming to have obtained certain data...The full scope of affected data sets has not yet…...
CMS fraud war room stops $203M in debated Medicaid payments
1+ mon, 2+ week ago (682+ words) government away from the traditional "pay and chase" recovery models toward real-time interception using data...New data released by the CMS on Tuesday indicate the strike force is working, with actions against 50...Room is what modern program integrity looks like:…...
Pharma loses appeal to change 340B drug discounts to rebates
1+ mon, 3+ week ago (714+ words) mechanism, holding that federal officials -- not pharmaceutical companies -- control 340B program administration...wholesale acquisition cost, then wait to receive a rebate from the drug company after submitting claims data...hospitals would have to front enormous sums of cash and expend millions…...
Survey: Front-end workflows to blame for most claim denials
3+ week, 4+ day ago (593+ words) challenge, according to the survey of more than 400 industry leaders conducted by revenue cycle management...RCM leaders also still reported persistent issues with missing or invalid claim data (35%) and medical...strategy for preventing claim denials, with 61% of respondents, was validation…...
Care continues shift to outpatient as hospital margins dip
2+ mon, 8+ hour ago (719+ words) hospital care happens is fundamentally shifting, according to the latest hospital financial performance data...healthcare consulting firm released its monthly National Hospital Flash Report yesterday, drawing on data...They are also considering how their organizations' revenue cycle management technology can…...
HHS cut 3M ACA Marketplace enrollments in ongoing fraud efforts
2+ mon, 2+ week ago (453+ words) A new HHS report contends the Trump Administration has rooted out nearly 3 million fraudulent Affordable...health experts say the changes improved access to affordable health insurance coverage, ASPE said its data...The Trump Administration's Marketplace Integrity and Affordability Rule helped…...
CMS locks in 2%+ payment bumps for SNFs, post-acute care providers
1+ mon, 2+ week ago (999+ words) The data submission timeline in the quality reporting program will also be shorter, going from 4.5 months...SNFs will also need to submit minimum data set information for all residents, regardless of payer....The CMS said this revised timeline will reduce…...
Medical supply companies banned in $3.4B fraud takedown
5+ day, 8+ hour ago (393+ words) Anti-Fraud Task Force, CMS is protecting the Medicare Trust Funds and its beneficiaries by using advanced data...The Trump administration has prioritized rooting out healthcare fraud, waste and abuse, launching the...Jacqueline LaPointe is an Executive Editor at Xtelligent Healthcare…...
OIG calls on states to tamp down Medicaid provider fraud
1+ mon, 2+ week ago (652+ words) This report comes as part of the Trump Administration's overall healthcare fraud crackdown....OIG used self-reported data from 43 states on how those states work with MCOs to flag and report potential...
Payers say AI doesn't deny care. The truth is more complex.
2+ week, 6+ day ago (1197+ words) to Stacie Sutter, vice president of payer strategy at Ensemble Health Partners, a revenue cycle management...company that handles medical billing and claims management for providers....