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Humana will reduce its Medicare Advantage footprint again in 2027. The Centers for Medicare & Medicaid Services will end a Medicare Part D premium stabilization program. And the American Red Cross has declared a national blood supply crisis. Listen to the latest episode of The Gist Healthcare Podcast. Hosted on Acast. See acast.com/privacy for more information.
The Friday Five for July 31, 2026: RegEd CE Courses Available on IntegrityCONNECT Fresh Take on Social Platforms: ThingsBook Medicare GLP-1 Bridge Reminder CMS Files Appeal to Clover Decision CMS & HHS File Expedited Appeal to Colombus I Get Connected:
Administrator of the U.S. Centers for Medicare and Medicaid Services, Dr. Mehmet Oz joins Bill to react to Dr. Anthony Fauci's refusal to answer questions before a Senate hearing, COVID missteps, vaccinations, and America's health concerns. Learn more about your ad choices. Visit megaphone.fm/adchoices
Referrals are a powerful lead generating tool, especially for insurance agents! Find out more in this explainer on referral marketing how to implement this strategy into your insurance business. Read the text version Get Connected:
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Drs. Michael Mack and Tom Nguyen about the proposed US Centers for Medicare & Medicaid Services changes to how cardiologists and cardiac surgeons interact during transcatheter aortic valve replacement (TAVR) procedures. Chapters 00:00 Intro 01:21 TAVR Heart Team 04:08 JANS 1+2, JACC TAVR vs SAVR 12:19 JANS 3, TAVR Short-Term Outcomes 14:06 JANS 4, SAVR Life Expectancy 17:44 JANS 5, WSJ TAVR Article 19:19 Video 1, Direct AA Cannulation Technique 21:23 Video 2, Endoscopic Redo TVR After CABG 24:25 Video 3, Gaudiani Cox-Maze III 27:33 Dr. Mack & Nguyen, TAVR Heart Team 51:12 Closing Dr. Mack explained the current heart team system, established in 2011 through collaboration with the US Food and Drug Administration (FDA) and CMS, which has been highly successful in ensuring safe and effective TAVR implementation. He argues that the proposed CMS changes could potentially dismantle this collaborative approach by allowing asynchronous patient evaluation and procedures to be performed by single operators without surgeon involvement. Dr. Nguyen provided insights from a system leader's perspective, noting that while the proposed changes raise significant concerns about patient care and data collection, some cardiologists argue that surgeons are already not actively involved in many programs, making the single operator model the norm in practice. Both expressed concern that without mandatory surgeon participation and TAVR registry involvement, smaller programs may adopt practices that lack proper accountability and could lead to inappropriate patient selection and outcomes, potentially creating more contentious debates between TAVR and surgical approaches. Joel also highlights recent JANS articles including a propensity-matched analysis comparing 10-year outcomes after SAPIEN 3 TAVR in the PARTNER 2 SAPIEN 3 Intermediate-risk Registry with surgery in the PARTNER 2A trial; a single-center retrospective study evaluated 61 patients who underwent cardiac surgery after prior TAVR during a 10-year period at a high-volume academic center; whether surgical aortic valve replacement (SAVR) should remain the first choice for aortic stenosis in patients with a life expectancy beyond five years; and an article examining the dramatic rise in the popularity of transcatheter aortic valves, early valve failure, and the impact it has on patients' lives. In addition, Joel explores axillary cannulation as a primary cannulation strategy, beating-heart endoscopic tricuspid valve replacement for high-risk redo patients after CABG and device-related tricuspid valve injury, and a Cox-Maze III operation combined with a left internal mammary artery (LIMA) to left anterior descending artery (LAD), as well as an ascending aortic replacement and aortic valve resuspension. Before closing, Joel highlights upcoming events in CT surgery. JANS Items Mentioned 10-Year Outcomes of SAPIEN 3 Transcatheter Aortic Valve Replacement or Surgery in Intermediate-Risk Patients A Decade of Cardiac Surgery After Transcatheter Aortic Valve Replacement: Short-Term Clinical Outcomes at a High-Volume Center Great Debate: Surgical Aortic Valve Replacement Is First Choice for Aortic Stenosis in Patients With a Life Expectancy Beyond 5 Years A Breakthrough Heart Procedure Comes With Risky Tradeoffs CTSNet Content Mentioned Direct Axillary Artery Cannulation With the Open Seldinger Technique Endoscopic Redo Tricuspid Valve Replacement After CABG The Cox-Maze III Procedure Combined With Valve-Sparing Aortic Surgery and CABG Other Items Mentioned Centers for Medicare & Medicaid Services Database—TAVR Career Center CTSNet Events Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
Our recent blog post about a Medicare Part B vaccine billing update highlighted a clarification from Centers for Medicare & Medicaid Services. In this GAAP episode, our VP and health care cost report expert, Mark Lyons, provides a little more color to the situation and what it means for Rural Health Clinics and Federally Qualified Health Centers. Take 10 minutes to listen in to learn more!
President Donald Trump welcomed Lebanese President Joseph Aoun to the White House Tuesday to discuss ways to implement the Trilateral Framework, the U.S.-backed deal between Lebanon and Israel that was signed on June 26. Both leaders said they would address the deal's goals to expand Lebanese military control in the country's south, reduce Hezbollah's presence, and enable a phased Israeli withdrawal from Lebanese territory.Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. announced that the federal government will pause more than $1 billion in Medicaid payments to California and Minnesota over alleged fraud. Kennedy said HHS and the Centers for Medicare and Medicaid Services are using artificial intelligence and other tools to identify suspicious activity.New Jersey found around 6,600 non-citizens on its voter rolls due to a software error in the state's Motor Vehicle Commission system between June 2023 and June 2024. Gov. Mikie Sherrill said under 400 voted illegally and that she was “appalled” by the situation. The White House said in a press release that this error highlights the need to pass the SAVE America Act, which Republicans say will ensure election integrity.More Breaking News, Special Reports, and Live Coverage on NTD: https://ept.ms/NTD_LIVE
When your client has diabetes, what does (and doesn't) Medicare cover? We talk about how diabetes treatments, supplies, and services are covered by the different parts of Medicare so you can help your clients know what to expect. Read the text version Get Connected:
Welcome back to a special encore presentation of Turn on the Lights! As we continue our transition series, our new host, Dr. Philip, is revisiting some of the most impactful conversations from the archives. For this episode, he selected a standout discussion with Dr. Michelle Schreiber and Brenna Rabel, exploring how quality measures are developed, adopted, and implemented across Medicare and Medicaid programs. Summary: How do we decide what “good care” looks like, and who gets to choose the scorecard? In this episode of Turn on the Lights, Kedar Mate speaks with Dr. Michelle Schreiber of the Centers for Medicare & Medicaid Services and Brenna Rabel of Battelle about how quality measures are developed, adopted, and applied across Medicare and Medicaid programs. They explore why measurement is essential for accountability, patient choice, and improvement, while also acknowledging its vulnerability to politics, feasibility constraints, and “teaching to the test.” Using diabetes and sepsis as examples, they explain how performance cutoffs are established, why “all-or-none” measures often face resistance, and what makes complex measures difficult to report and score. The conversation also addresses efforts to reduce reporting burden, including CMS's shift from broader MIPS reporting toward MIPS Value Pathways and the expansion of digital quality measurement through FHIR-enabled eCQMs. They conclude with a forward-looking discussion on how artificial intelligence could reduce manual chart abstraction and advance quality measurement, particularly as patient-reported outcomes play a larger role in shaping the future of value-based care. Tune in to hear how measures shape what health systems prioritize, what gets improved, and what “value” could look like in the future. Resources: Connect with and follow Dr. Michelle Schreiber on LinkedIn. Follow CMS on LinkedIn and explore their website! Connect with and follow Brenna Rabel on LinkedIn. Follow Battelle on LinkedIn and explore their website! Learn more about your ad choices. Visit megaphone.fm/adchoices
$100 billion. It's a huge number but that's the total amount the Trump Administration believes it can find in fraud across Medicaid and Medicare by 2029. The person helping lead that initiative is Stephanie Carlton, the deputy administrator of the Centers for Medicare and Medicaid Services. She's now directing efforts to make CMS an “AI […] The post Can AI Find Medicaid Fraud? That's the Mission of Stephanie Carlton, Dep. Admin, CMS appeared first on Healthy Communities Online.
12 - Do the Republicans finally have a leg to stand on by standing up to communism? Why does Dom love what Mike Johnson is saying? 1210 - Side - fictional character that deserves a statue 1215 - Who's more dangerous to Americans? Immigrants or Americans? 1230 - Administrator of the US Centers for Medicare and Medicaid Services, Dr. Mehmet Oz is back on the show. Did he think he'd be dealing with this much fraud in his position? Why are people upset at Medicaid qualifications when the bar is on the floor for coverage? Can Josh Shapiro stand up to this? What does Dr. Oz have to say about Lindsey Graham and how something like that can be prevented? 1250 - Do Democrats care about fraud? Your calls. 1 - Did Patti LeBelle mess up the anthem last night? 110 - Sunny Hostin doubles down again and even equates the American flag to the Confederate one. 115 - How much should dry cleaning be? 120 - Has bowling become unaffordable? 130 - Who is Kathy Hochul blaming for business leaving New York? 140 - Your calls. 150 - Dom Giordano Presents: Progressive Women Gone Wild! Why are locals railing against the Bensalem School District? 155 - Are you calling Benny? 2 - What is the Philadelphia Public Schools problem? 210 - Your calls. 215 - Dom's Money Melody! 225 - Who will be AG? Todd Blanche? What do you think about the The Philly Parallel Parking Championship? 230 - How many miles of bike lanes are in the city? 235 - Your calls. 250 - The Lightning Round!
12 - Do the Republicans finally have a leg to stand on by standing up to communism? Why does Dom love what Mike Johnson is saying? 1210 - Side - fictional character that deserves a statue 1215 - Who's more dangerous to Americans? Immigrants or Americans? 1230 - Administrator of the US Centers for Medicare and Medicaid Services, Dr. Mehmet Oz is back on the show. Did he think he'd be dealing with this much fraud in his position? Why are people upset at Medicaid qualifications when the bar is on the floor for coverage? Can Josh Shapiro stand up to this? What does Dr. Oz have to say about Lindsey Graham and how something like that can be prevented? 1250 - Do Democrats care about fraud? Your calls.
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning discusses the Centers for Medicare & Medicaid Services proposed decision memo regarding the national coverage analysis for transcatheter aortic valve replacement (TAVR). Chapters 00:00 Intro 01:17 TAVR National Coverage 06:05 JANS 1, EPOCH CardioLink-10 Trial 10:20 JANS 2, Dacron Ross Autograft Analysis 12:23 JANS 3, Mech vs Biopros Valve Outcomes 15:53 Video 1, Ross Procedure I/E Reduction 19:18 Video 2, Hemi-Commando Procedure 22:14 Video 3, Left VATS Enucleation Leiomyoma 24:15 Dr. Meguid, Intraop Molecular Imaging 35:52 Closing He outlines crucial deadlines, actionable steps for surgeons, the importance of submitting public comments, and the necessity of data collection. Additionally, he spoke with Dr. Robert Meguid, Professor of Surgery at the University of Colorado Anschutz Medical Campus, Aurora, CO, USA, about intraoperative molecular imaging. They explore how this technology identifies small nodules, the functionality and use cases of the specialized camera, the associated learning curve, and other available systems. The conversation also touches on robotics, lymph node staging, and cost. Furthermore, Dr. Meguid shares insights on his frequency of use of this technique. Joel also highlights recent JANS articles on a systematic review and meta-analysis on how complete Dacron reinforcement of Ross autograft does not increase neo-aortic valve regurgitation, a randomized trial on superficial parasternal intercostal plane block with ropivacaine vs placebo for opioid exposure after cardiac surgery, and outcomes after conversion from mechanical to bioprosthetic valves for anticoagulation-related complications. In addition, Joel explores the Ross procedure with internal and external reduction annuloplasty using autologous tissue rings, hemi-commando procedure for bioprosthetic aortic valve endocarditis, and left-sided uniportal VATS enucleation of a large esophageal leiomyoma. Before closing, Joel highlights upcoming events in CT surgery. JANS Items Mentioned Complete Dacron Reinforcement of Ross Autograft Does Not Increase Neo-Aortic Valve Regurgitation: A Systematic Review and Meta-Analysis Superficial Parasternal Intercostal Plane Block With Ropivacaine Versus Placebo for Opioid Exposure After Cardiac Surgery (EPOCH CardioLink-10): A Multicentre, Double-Blind, Randomised Trial Outcomes After Conversion From Mechanical to Bioprosthetic Valves for Anticoagulation-Related Complications CTSNet Content Mentioned Ross Procedure With Internal and External Reduction Annuloplasty Using Autologous Tissue Rings Hemi-Commando Procedure for Bioprosthetic Aortic Valve Endocarditis Left-Sided Uniportal VATS Enucleation of a Large Esophageal Leiomyoma Other Items Mentioned Centers for Medicare & Medicaid Services Database—TAVR Career Center CTSNet Events Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
Did you know that CMS estimates three million Medicare beneficiaries aren't enrolled in the government's Medicare Extra Help program but could benefit from it? In this episode of the Agent Survival Guide, we see what this program is and how it can help your clients. Read the text version Get Connected:
Staying safe during extreme heat Dangerous, record-breaking heat has hit much of the nation this week, with the National Weather Service issuing an Extreme Heat Warning for the state of Ohio lasting until Thursday night. Many outdoor events have been canceled due to safety. The City of Cleveland canceled all youth outdoor sports through Friday, a Wade Oval Wednesday concert was canceled in University Circle, and the Cleveland Orchestra's free concert at Cain Park has been postponed, all due to dangerous conditions. This week, temperatures have hit the mid-to-high 90s, and Thursday the humidity will make the temperature feel as high as 107 degrees. To try to combat the heat, many cooling centers have opened around the region. We'll start Thursday's "Sound of Ideas" talking about how can to protect ourselves from heat-related injuries this week and throughout the summer. And, ahead of one of the most injury-prone holidays in the U.S., we'll ask our experts about staying safe this Fourth of July holiday. Guests: - Ellen Kazimer, Administrative Commander & Public Information Officer, Cleveland EMS - Tamanna Singh, M.D., Director, Sports Cardiology Center & Co-Founder & Co-Director, Women's Integrated Sports, Exercise, & Research Center, Cleveland Clinic & Volunteer, American Heart Association Medicare Pilot Program Ohio is one of six states testing out a Medicare pilot program that the federal government hopes will reduce fraud or waste in the system. The Centers for Medicare & Medicaid Services program WISeR, or Wasteful and Inappropriate Service Reduction, adds prior authorization for certain services that the government deems costly and unnecessary, and it operates using artificial intelligence. The government says the program will save money at the federal level and protect patients from unneeded care, but critics say its rollout since January has been rocky, leading to errors or delayed care, and reimbursement delays of up to 8 weeks to healthcare providers. An audience member inspired us to look more into this program on a show last week about aging well. Anita in Cleveland Heights called and said she was a senior on traditional Medicare and was shocked to discover after the fact that she needed pre-approval from her insurance to see certain doctors, and was facing a hefty bill that she would now need to appeal. Guests: - Gary Katz, M.D., President, Ohio State Medical Association - Darius Tahir, Correspondent, KFF Health News Ohio Revolutionary War graves As America approaches its 250th birthday, Americans are paying a bit more attention the country's founding, and the events surrounding 1776. Over the last year, more than 500 Ohioans volunteering their time took part in collecting data about those who actually served in the Revolutionary War. The Revolutionary War Graves Identification Project was an undertaking from the Ohio History Connection with the purpose of verifying and documenting the final resting places of those veterans buried in Ohio. Ideastream's Drew Maziasz spoke with Krista Horrocks from the Ohio History Connection about the graves project. The final public release of the grave survey will come out on July 4. Guest: - Krista Horrocks, Project Manager, Ohio History Connection
Rural Health News is a weekly segment of Rural Health Today, a podcast by Hillsdale Hospital. News sources for this episode: Forvis Mazars, “CMS Rule Signals Shift in Medicaid State-Directed Payments,” June 11, 2026, https://www.forvismazars.us/forsights/2026/06/cms-rule-signals-shift-in-medicaid-state-directed-payments. Medicaid.gov, “State Directed Payments,” https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments. Sturgis Hospital, “Sturgis Hospital Closure,” https://sturgishospital.com/sturgis-hospital-closure/. The Association of American Medical Colleges, “AAMC Statement on Proposed Rule on Medicaid Supplemental Payments,” May 21, 2026, https://www.aamc.org/news/press-releases/aamc-statement-proposed-rule-medicaid-supplemental-payments. U.S. Department of Health & Human Services, “Proposed Rule: Medicaid Managed Care State Directed Payments and Medicaid Fee-For-Service Targeted Medicaid Practitioner Payments (CMS-2449-P),” May 20, 2026, https://www.hhs.gov/guidance/document/proposed-rule-medicaid-managed-care-state-directed-payments-and-medicaid-fee-service. Michigan Health & Hospital Association, “CMS Releases FY 2027 Hospital Inpatient Prospective Payment System Proposed Rule,” April 17, 2026, https://www.mha.org/newsroom/cms-releases-fy-2027-hospital-inpatient-prospective-payment-system-proposed-rule/. Federal Register, “Medicaid Program; Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments,” May 22, 2026, https://www.federalregister.gov/documents/2026/05/22/2026-10292/medicaid-program-medicaid-managed-care-state-directed-payments-and-medicaid-fee-for-service-targeted. Centers for Medicare & Medicaid Services, “Medicaid Managed Care State Directed Payments and Medicaid Fee-For-Service Targeted Medicaid Practitioner Payments Proposed Rule (CMS-2449-P,” May 20, 2026, https://www.cms.gov/newsroom/fact-sheets/medicaid-managed-care-state-directed-payments-medicaid-fee-service-targeted-medicaid-practitioner. Andrea Hooten, “New Rural Health Hub Connects Arkansans to Healthcare Resources, Opportunities,” June 15, 2026, https://news.uams.edu/2026/06/15/new-rural-health-hub-connects-arkansans-to-healthcare-resources-opportunities/, University of Arkansas for Medical Sciences News. Rural Health Today is a production of Hillsdale Hospital in Hillsdale, Michigan and a member of the Health Podcast Network. Our host is JJ Hodshire, our producer is Kyrsten Newlon, and our audio engineer is Kenji Ulmer. Special thanks to our special guests for sharing their expertise on the show, and also to the Hillsdale Hospital marketing team. If you want to submit a question for us to answer on the podcast or learn more about Rural Health Today, visit ruralhealthtoday.com.
The Friday Five for June 19, 2026: Certification for AEP 2027 Coming June 22 Microsoft Teams Location Tracking Medicare GLP-1 Bridge Starts July 1 CMS to Codify Medicare Drug Price Negotiation Federal Judge Vacates Several CMS ACA Provisions Get Connected:
The Friday Five for June 12, 2026: Apple WWDC 2026 Takeaways Instagram Grid Arrangement Feature IntegrityCONNECT Annuities & What's Coming Soon KFF MA Enrollment Stats & Trends for 2026 CMS Medicaid Work Requirements Get Connected:
In the first episode of this two-part 20-Minute Health Talk, Chethan Sathya, MD, sits down with Don Berwick, MD — former Center for Medicare and Medicaid Services administrator (CMS) and founder of the Institute for Healthcare Improvement (IHI). Dr. Berwick traces his path from early harrowing medical experiences to a career dedicated to improving patient care and healthcare delivery. The conversation moves to how patient solidarity could become a force for change and why simplifying to a single, public payer could create conditions that could fix the delivery of health care while actually improving patient choice and lowering costs. Northwell is New York State's largest healthcare provider and private employer, with 28 hospitals, 890 outpatient facilities and more than 16,600 affiliated physicians. We're making breakthroughs in medicine at the Feinstein Institutes for Medical Research. We're training the next generation of medical professionals at the visionary Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Hofstra Northwell School of Nursing and Physician Assistant Studies. Get the latest news and insights from our experts in the Northwell Newsroom: Press releases Insights Podcasts Publications Interested in a career at Northwell Health? Visit our career site and explore our many opportunities. Watch episodes of 20-Minute Health Talk on YouTube. For information on our more than 100 medical specialties, visit Northwell.edu and follow us @NorthwellHealth on Facebook, Instagram, X and LinkedIn.
1 - What is the craze about NYC? What will happen at the Knicks game tonight regarding Trump? 105 - Dom agrees with Madeleine Dean? Why do people support a literal Nazi? 110 - Why does this WNBA player oppose wearing “America 250” on her uniform? 130 - Dr. Mehmet Oz, the Administrator of the US Centers for Medicare and Medicaid Services, joins us today. Does he think Kensington is getting better after his visit last month? What's the biggest problem in a neighborhood like that? What is being done about Medicare and eBT fraud? What kind of people is Dr. Oz and his office going after? What does Dr. Oz think of Trump attending the NBA Finals tonight? Dr. Oz played in the Celebrity All-Star Game? 150 - Dom Giordano Program Presents: Progressive Women Gone Wild!
12 - Does Scott Pelley really believe there's no media bias? Is his service as a journalist on par with our soldiers that served? 1205 - Is Larry Krasner going after Cherelle Parker? Is something fishy going on with California's vote counting? 1215 - Side - song that is summer 1220 - Did Dom really get off at Trenton on his way back from Hempstead? What else did he encounter? 1240 - Bestselling author, Contributing Editor at National Review & Former Chief Asst. U.S. Attorney during “The Blind Sheikh” trial Andy McCarthy is here. With The Blind Sheikh's defense attorney running and likely winning a Congressional seat in New Jersey, what can Andy tell us about that case years ago? How are candidates like this propped up by craziness like we see on college campuses? 1250 - Your calls to round out the hour. 1 - What is the craze about NYC? What will happen at the Knicks game tonight regarding Trump? 105 - Dom agrees with Madeleine Dean? Why do people support a literal Nazi? 110 - Why does this WNBA player oppose wearing “America 250” on her uniform? 130 - Dr. Mehmet Oz, the Administrator of the US Centers for Medicare and Medicaid Services, joins us today. Does he think Kensington is getting better after his visit last month? What's the biggest problem in a neighborhood like that? What is being done about Medicare and eBT fraud? What kind of people is Dr. Oz and his office going after? What does Dr. Oz think of Trump attending the NBA Finals tonight? Dr. Oz played in the Celebrity All-Star Game? 150 - Dom Giordano Program Presents: Progressive Women Gone Wild! 2 - This substack on the Philadelphia Republican Party should be an eye opener for the establishment, but puts into context how much the party cannibalizes itself. 205 - Your calls. 210 - Dom's Money Melody! 220 - More of your calls. 235 - What are Guy Ciarrocchi's 10 Commandments of The Left? More calls. 250 - The Lightning Round!
The Friday Five for June 5, 2026: Certification Reminder Pod Rec: Before Breakfast TRICARE Resources for Agents Clover Health Star Ratings 2027 MA and Part D Max Commissions Get Connected:
Trump administration cabinet members and other federal and state officials denounced fraud in Medicaid and various government programs during a news conference in central Ohio. Acting U.S. Attorney General Todd Blanche was joined by FBI Director Kash Patel, Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, and other officials. They announced the indictment of 14 people accused of schemes involving Medicaid providers, behavioral health services for people with autism and a romance fraud operation. More than 100 cameras at the Cuyahoga County Jail were found to be malfunctioning in January 2022. Officials were aware of the problem, but it took four years to replace them, according to reporting by The Marshall Project Cleveland. County officials said the project required more than $220,000 and that the funding did not become available until late last year. Properties used as short-term rentals through services such as Airbnb and Vrbo must now register with the city and comply with other new regulations approved by Cleveland City Council this week. The new wave band Devo performed at the Akron Civic Theatre on Wednesday. To commemorate the band's first show in Kent, state Rep. Michele Grim, D-Toledo, has introduced House Bill 866, which would designate April 18 as Devo Day in Ohio. These stories and more will be part of this week's discussion on the “Sound of Ideas Reporters Roundtable.” Guests:- Matt Richmond, Criminal Justice Reporter, Ideastream Public Media- Gabriel Kramer, Reporter/Producer, Ideastream Public Media- Karen Kasler, Bureau Chief, Ideastream Statehouse News Bureau
Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services, said on Tuesday that the Trump administration is increasing transparency on drug prices by adding 160 more medications to TrumpRx. He added that his agency is aggressively going after states for fraud in the Medicaid and Medicare programs.Acting Attorney General Todd Blanche says that the Trump administration is scrapping plans to create a $1.8 billion fund meant to compensate victims of government weaponization. Blanche says during a House hearing, "We are not moving forward with the fund, period."Secretary of State Marco Rubio testifies before the Senate Foreign Relations Committee about the State Department's budget request. He answers questions on the Trump administration's approach to Iran and Cuba.
Multiple Minnesota disability and addiction recovery services providers are scrambling to figure out what's next after they received notice on Monday they were removed from 14 high-risk Medicaid programs.The removal came from a state Department of Human Services process to revalidate 5,000 providers by May 31. DHS was required to do so through an agreement between the state and the federal government's Center for Medicaid Services, which was part of the Trump Administration's campaign to address fraud in Minnesota.Jordan Hansen, CEO of YourPath, an addiction recovery services provider and Cari McCann, executive director of Great River Homes, which provides care to individuals with disabilities, say their organizations were kicked off of the Medicaid programs. They joined MPR News host Nina Moini to talk about what comes next.Read more at MPRnews.org.
A must-listen episode: Host Dr. Jay Anders welcomes Kimberly Brandt, Chief Operating Officer and Deputy Administrator at the Centers for Medicare & Medicaid Services. Together they discuss slow value-based care adoption in Medicare, CMS's data quality push through FHIR APIs and USCDI, and how AI will help flag fraud across millions of daily claims. Brandt also discusses what it means for CMS to pay for 'outcomes rather than transactions'. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/
The 2027 Marketplace Final Rule from CMS is here! Join Sarah as she pulls out takeaways for insurance agents selling ACA plans. Get Connected:
From WEDI's Spring Conference, Amy Gleason (Centers for Medicare & Medicaid Services) and Ryan Howells (CARIN Alliance, Leavitt Partners) explore the vision behind the CMS Health Tech Ecosystem and its potential to transform how health data is accessed, exchanged, and used across the healthcare system. The discussion examines the value this approach could deliver for patients, providers, and innovators, while also highlighting how industry stakeholders can help build a more connected, interoperable, and consumer-centered digital health landscape.
Dr. Mehmet Oz, 17th Administrator of the Centers for Medicare & Medicaid Services, joins Sid live in-studio to discuss the scope of fraud in healthcare services, explaining how half of the fraud in the federal government could be originating from Medicaid and Medicare services. Learn more about your ad choices. Visit megaphone.fm/adchoices
Dr. Mehmet Oz, 17th Administrator of the Centers for Medicare & Medicaid Services, joins Sid live in-studio to discuss the scope of fraud in healthcare services, explaining how half of the fraud in the federal government could be originating from Medicaid and Medicare services. Learn more about your ad choices. Visit megaphone.fm/adchoices
The Friday Five for May 8, 2026: Quick Hits & Headlines CMS Admin Dr. Oz on Prior Auth Audio to Help You Sleep Cigna to Exit ACA for CY 2027 AHIP & NABIP Dates for CY 2027 Get Connected:
While Centers for Medicare & Medicaid Services does not explicitly define a strict “12-month rule,” its guidance does require that the physician’s involvement reflect ongoing, active participation in the patient’s course of treatment. That said, legal and compliance experts consistently caution that if a physician has not personally seen a patient within 12–24 months, billing subsequent non-physician practitioner (NPP) visits as “incident to” may present elevated audit risk. Terry breaks down the lack of clear regulatory thresholds and outlines practical steps to help protect your practice if an audit inquiry occurs. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Incident to Physician Participation Rules appeared first on Terry Fletcher Consulting, Inc..
Host Radell Lewis sits down with Laura, candidate for Ohio's 7th Congressional District, to break down one of the most flippable Republican seats heading into 2026. Once a R+15 district, OH-7 is now R+5 after redistricting, and incumbent Max Miller squeaked by at 51 percent even in a friendlier map. With recent child abuse allegations surfacing against Miller and a brand new county (Ashland) full of farmers no one has bothered to talk to, this race has every ingredient for a flip. Laura brings 23 years of federal public service to the conversation, including work at the Centers for Medicare and Medicaid Services and the U.S. Department of Education Office for Civil Rights in Cleveland (an office that no longer exists thanks to this administration). Growing up between Cleveland and rural Athens County, she served patients, families, children, workers, veterans, and communities across seven federal agencies before being purged by DOGE last year. She has shown up in Northeast Ohio for years through boards, commissions, task forces, and community work. She is not running because politics is a career move. She is running because too many people in this district are being priced out, pushed aside, and told to expect less. In this conversation we cover: the unconstitutional war in Iran and why ending it lowers prices, Medicare for All as a today-not-tomorrow policy, the fifteen dollar minimum wage fight, why corporate capture of farmland and homes is the real threat, the Mamdani playbook for transparent representation, the loss of plausible deniability when this administration finds money for Argentina and Iran but not for working families, the dangers of party hypocrisy and the politics of exclusion, a humanist take on faith communities and the loneliness epidemic, and an honest assessment of Gaza, Israel, and the case for a two-state solution rooted in diplomacy rather than blank-check military aid. This is local politics done right: nuanced, honest, and built around results for actual constituents. Whether you lean left, right, or somewhere in the middle, this episode is for anyone who believes that the person we send to Congress should have the spine, the ethics, and the experience to challenge corruption on both sides of the aisle. Learn more about Laura's campaign at https://LauraforUs.com New episodes of Purple Political Breakdown drop weekly. Political solutions without political bias.Standard Resource Links & RecommendationsThe following organizations and platforms represent valuable resources for balanced political discourse and democratic participation: PODCAST NETWORKCheck Out the Podcast Website: www.purplepoliticalbreakdown.comALIVE Podcast Network - Check out the ALIVE Network where you can catch a lot of great podcasts like my own, led by amazing Black voices. Link: https://alivepodcastnetwork.com/ CONVERSATION PLATFORMSHeadOn - A platform for contentious yet productive conversations. It's a place for hosted and unguided conversations where you can grow a following and enhance your conversations with AI features. Link: https://app.headon.ai/Living Room Conversations - Building bridges through meaningful dialogue across political divides. Link: https://livingroomconversations.org/ UNITY MOVEMENTSUs United - A movement for unity that challenges Americans to step out of their bubbles and connect across differences. Take the Unity Pledge, join monthly "30 For US" conversation calls, wear purple (the color of unity), and participate in National Unity Day every second Saturday in December. Their programs include the Sheriff Unity Network and Unity Seats at sports events, proving that shared values are stronger than our differences. Link: https://www.us-united.org/ BALANCED NEWS & INFORMATIONOtherWeb - An AI-based platform that filters news without paywalls, clickbait, or junk, helping you access diverse, unbiased content. Link: https://otherweb.com/ VOTING REFORM & DEMOCRACYEqual Vote Coalition & STAR Voting - Advocating for voting methods that ensure every vote counts equally, eliminating wasted votes and strategic voting. Link: https://www.equal.vote/starFuture is Now Coalition (FiNC) - A grassroots movement working to restore democracy through transparency, accountability, and innovative technology while empowering citizens and transforming American political discourse. Link: https://futureis.org/ POLITICAL ENGAGEMENTIndependent Center - Resources for independent political thinking and civic engagement. Link: https://www.independentcenter.org/ GET DAILY NEWSText 844-406-INFO (844-406-4636) with code "purple" to receive quick, unbiased, factual news delivered to your phone every morning via Informed (https://informed.now)Check Out the Unfuck America Tour & National Ground Game: https://www.nationalgroundgame.com/Check Out the CIVICS App to Know More About Your Politicians: https://www.civicpolitics.com ALL LINKShttps://linktr.ee/purplepoliticalbreakdownThe Purple Political Breakdown is committed to fostering productive political dialogue that transcends partisan divides. We believe in the power of conversation, balanced information, and democratic participation to build a stronger society. Our mission: "Political solutions without political bias."Subscribe, rate, and share if you believe in purple politics - where we find common ground in the middle! Also if you want to be apart of the community and the conversation make sure to Join the Discord: https://discord.gg/ptPAsZtHC9
The Friday Five for May 1, 2026: [00:44] Staying Caffeinated on the Road [03:26] Healthcare or Health Care? AP Stylebook Makes it Official [05:24] Spotify Spins Fitness into the Mix [08:41] Medicare Advantage Improvement Act of 2026 [12:16] CMS Update on BALANCE Model & Medicare GLP-1 Bridge Events & Webinars for Insurance Agents Get Connected:
Health Affairs Publishing's Jeff Byers welcomes Senior Editor Michael Gerber back to the pod to discuss recent federal action on prior authorization, including CMS's proposal to expand response-time requirements to prescription drugs. The conversation also covers insurer efforts to reduce prior auth volume, the promise of AI and prior authorization, and what increased transparency could reveal about costs.To learn more, check out our recent Insider trend report on the current prior authorization landscape. And if you haven't already, join Insider today to get access to exclusive events, newsletters, cheat sheets, and reports.Related Links:CMS proposes new deadlines for prior authorizations for drugs (Healthcare Dive)2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule (CMS)A Rule by the Centers for Medicare & Medicaid Services on 02/08/2024 (Federal Register)Health Plans Reduce Prior Authorization, Support Continuity of Care and Enhanced Consumer Communications (Blue Cross Blue Shield)AI speeds up prior auth, coding while driving higher costs for health systems: PHTI report (Fierce Healthcare)Sign up for our free Health Affairs newsletters to stay up to date on health policy news and analysis.
The Friday Five for April 17, 2026: [00:57] CMS 2027 MA and Part D Final Rule [02:09] Google Announces New Chrome Features [04:56] March 2026 CPI/2026 FOMC Calendar [07:03] Protective Life Corporation Study on Gaps in Medicare Knowledge [10:17] CMS 2026 Prior Authorization Proposed Rule Get Connected:
CMS recently published the 2027 Medicare Advantage and Part D Final Rule. Don't miss the ASG Podcast top takeaways for insurance agents. Get Connected:
Rural Health News is a weekly segment of Rural Health Today, a podcast by Hillsdale Hospital. News sources for this episode: Lauren Weber, “RFK Jr. and Dr. Oz have a plan to save rural health care. Here's the catch.,” March 24, 2026, https://www.detroitnews.com/story/news/nation/2026/03/24/rfk-jr-dr-oz-plan-save-rural-health-care-heres-catch/89297731007/, The Detroit News. The Washington Post, “RFK Jr. and Dr. Oz have a plan to save rural health care. Here's the catch.,” March 24, 2026, https://www.washingtonpost.com/health/2026/03/23/rural-health-ai-medical-tech/. Bridget Early, “Providers urge CMS to scrap ACA exchanges overhaul,” March 25, 2026, https://www.modernhealthcare.com/politics-regulation/mh-cms-aca-exchanges-rule-providers/, Modern Healthcare. Centers for Medicare and Medicaid Services, “CMS Proposes Regulations to Lower Health Care Costs, Expand Consumer Choice, and Protect Taxpayers,” https://www.cms.gov/newsroom/press-releases/cms-proposes-regulations-lower-health-care-costs-expand-consumer-choice-protect-taxpayers. Madeline de Figueirdo, “Virtual Crisis Care Helps Rural Communities Access Mental Health Resources in Emergencies,” March 2, 2026, https://dailyyonder.com/virtual-crisis-care-helps-rural-communities-access-mental-health-resources-in-emergencies/2026/03/02/, Daily Yonder. Rural Health Today is a production of Hillsdale Hospital in Hillsdale, Michigan and a member of the Health Podcast Network. Our host is JJ Hodshire, our producer is Kyrsten Newlon, and our audio engineer is Kenji Ulmer. Special thanks to our special guests for sharing their expertise on the show, and also to the Hillsdale Hospital marketing team. If you want to submit a question for us to answer on the podcast or learn more about Rural Health Today, visit ruralhealthtoday.com.
Learn about the value of Dual Eligible Special Needs Plans (D-SNPs) and how to get started selling! Read the text version Learn how you can get started selling D-SNPs by calling Ritter Insurance Marketing today at 800-769-1847. Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail.
The Friday Five for March 27th: Macbook Neo & WWDC26 Gas Buddy for Fuel Savings The Great Nee-Doh Shortage KFF State Health Facts Resource CMS Final Rule on Fax & Snail Mail Get Connected:
A rural Minnesota hospital system could be forced to close within weeks as millions of dollars in Medicare payments have been delayed. The Mille Lacs Health System is at risk of closing its hospital and rural health clinics that serve multiple counties. That's because the Centers for Medicare and Medicaid Services has withheld about $2.5 million dollars in Medicare payments since January.A new lawsuit is challenging the Trump Administration's move to fast-track deportations of Somalis. The Advocates for Human Rights — a Minneapolis nonprofit — is suing the Justice Department over its effort to speed up deportations of non-citizens from Somalia. The government had already targeted many for removal, but the plaintiffs allege that the administration is fast-tracking court hearings for Somalis after President Donald Trump called them "garbage."
In this episode of Cloud Wars Live, Bob Evans speaks with Seema Verma, Executive Vice President and General Manager of Oracle Health and Life Sciences, about how AI is reshaping the healthcare industry. Drawing on her experience leading the Centers for Medicare and Medicaid Services, Verma explains how Oracle is tackling one of the world's most complex sectors with an end-to-end, AI-driven approach. The conversation explores how automation, modern electronic health records, and intelligent agents can reduce administrative costs, improve patient care, and unify fragmented healthcare systems into a more efficient and responsive ecosystem. Oracle Healthcare Vision The Big Themes: AI as Healthcare Backbone: Oracle is not approaching healthcare transformation as a collection of isolated tools but as a unified, AI-driven ecosystem. Unlike past efforts that layered technology onto outdated systems, Oracle is rebuilding infrastructure from the ground up with AI at its core. This allows automation to flow across the entire system rather than remaining siloed. The result is a more cohesive healthcare environment where decisions, processes, and outcomes are interconnected, enabling true industry-wide transformation rather than incremental improvements. Clinical AI Agents in Action: One of the most compelling innovations discussed is Oracle's clinical AI agent, which listens to doctor-patient interactions and automatically generates notes, recommendations, and workflows. This technology goes beyond documentation — it initiates next steps such as prescribing medications, ordering tests, and suggesting billing codes. Physicians benefit from reduced administrative workload, allowing them to focus on patient interaction. Clinical Trials Transformation: Clinical trials are another area ripe for disruption, with only 1–2% of eligible patients participating due to outdated recruitment methods. Oracle is addressing this by matching patients to trials using real-time health data. Instead of manual processes like bulletin board sign-ups, AI can identify eligible participants and notify both clinicians and patients. The Big Quote: “Fifty percent, sixty percent of the costs are labor-oriented. And if we look at the growth in healthcare, that's not changing, we see high prices in drugs, one of the fastest-growing areas. And so here's where AI has an incredible opportunity here to really transform the industry and get rid of a lot of that repetitive, manual work and increase efficiency." More from Seema Verma: Connect with Seema on LinkedIn or learn more about Oracle, health, and AI. Visit Cloud Wars for more.
Dr. John Whyte has spent his career at the intersection of medicine, media and public policy. Now, as CEO of the American Medical Association, he hears firsthand what physicians, patients and health leaders are most concerned about and what they expect from the future of healthcare. That perspective makes him an ideal guest for Season 11 of Fixing Healthcare with cohosts Dr. Robert Pearl and Jeremy Corr. This season's guests bring more than impressive résumés and large social-media followings. They bring insight into what people across the country are actually talking about: the fears they express, the questions they ask and the expectations they carry into exam rooms, boardrooms and online conversations. Whyte has held leadership roles at the FDA and Centers for Medicare & Medicaid Services. He later became chief medical officer at WebMD and chief medical expert for Discovery Channel. In each position, he has focused on translating complex medical issues into clear, actionable information. In this conversation, he shares what he is hearing now and why the answers will require both cultural and structural change. Key highlights include: Three concerns dominate for physicians. Whyte opens by identifying what he hears most often across the country: frustration with prior authorization and payment incentives in Medicare and Medicaid, anxiety about scope-of-practice changes, and uncertainty about how physicians should lead (rather than react to) the rapid rise of digital health and generative AI. Medicaid disruption and impact on children. Whyte explains that policy changes at both federal and state levels could leave vulnerable populations without coverage or access to care. He emphasizes that nearly half of U.S. children rely on Medicaid. Payment models and physician autonomy. The discussion explores tensions between fee-for-service, Medicare Advantage and value-based approaches. Whyte argues that physicians must retain meaningful choice in how they practice and get paid, even as consolidation and employment models reduce autonomy. Generative AI as “augmented intelligence.” Whyte notes that more than 80% of physicians now use AI tools professionally, largely for documentation and communication tasks. The real opportunity, he says, lies in improving diagnosis, personalization and continuous monitoring. Home as the future site of care. From wearables to smart diagnostic devices, Whyte envisions a shift away from episodic office visits toward continuous monitoring and preventive care. Outcome-based reimbursement. Pearl asks whether paying for outcomes could unlock broader adoption of AI-enabled tools. Whyte acknowledges the promise but highlights practical challenges, including patient complexity, burnout and the risk that efficiency gains could simply lead to higher patient volumes. The evolving physician-patient relationship in the AI era. With a growing share of patients using generative AI before appointments, Whyte encourages clinicians to view digitally informed patients as partners. Open dialogue, trusted sources and shared decision-making, he argues, will define effective care in the years ahead. There's so much more to this episode. Tune in to find out what physicians and patients should expect from the future of medicine. * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn The post FHC #209: What the AMA’s new CEO is hearing from doctors & patients right now appeared first on Fixing Healthcare.
The Friday Five for March 20, 2026: Rueppel Recommends Audible launches Standard Plan Universal Health Services to Acquire Talkspace Manufacturer Participation in CMS 2028 Medicare Drug Price Negotiation Microsoft Announces Copilot Health Get Connected:
How do we decide what “good care” looks like, and who gets to choose the scorecard? In this episode of Turn on the Lights, Kedar Mate speaks with Dr. Michelle Schreiber of the Centers for Medicare & Medicaid Services and Brenna Rabel of Battelle about how quality measures are developed, adopted, and applied across Medicare and Medicaid programs. They explore why measurement is essential for accountability, patient choice, and improvement, while also acknowledging its vulnerability to politics, feasibility constraints, and “teaching to the test.” Using diabetes and sepsis as examples, they explain how performance cutoffs are established, why “all-or-none” measures often face resistance, and what makes complex measures difficult to report and score. The conversation also addresses efforts to reduce reporting burden, including CMS's shift from broader MIPS reporting toward MIPS Value Pathways and the expansion of digital quality measurement through FHIR-enabled eCQMs. They conclude with a forward-looking discussion on how artificial intelligence could reduce manual chart abstraction and advance quality measurement, particularly as patient-reported outcomes play a larger role in shaping the future of value-based care. Tune in to hear how measures shape what health systems prioritize, what gets improved, and what “value” could look like in the future. Resources: Connect with and follow Dr. Michelle Schreiber on LinkedIn. Follow CMS on LinkedIn and explore their website! Connect with and follow Brenna Rabel on LinkedIn. Follow Battelle on LinkedIn and explore their website! Learn more about your ad choices. Visit megaphone.fm/adchoices
Zeke Emanuel, Vice Provost for Global Initiatives at the Wharton School, joins the show to discuss recent reforms at the Centers for Medicare and Medicaid Services. The conversation covers site-neutral payments, strengthening primary care compensation, innovation models, and efforts to address waste and Medicare Advantage risk adjustment. They also examine the broader fiscal and policy implications for the $1.7 trillion agency. Hosted on Acast. See acast.com/privacy for more information.
Send a textOn this episode of the podcast, host Dave Knapp breaks down the latest updates on potential GLP-1 receptor agonists coverage for people on Medicare living with obesity. With new guidance released by the Centers for Medicare & Medicaid Services, the episode explains how two upcoming federal programs—the Bridge Program (2026) and the Balance Model (2027)—could expand access to medications like Zepbound and Wegovy.Listeners will learn who may qualify, how the proposed $50 monthly cost could work during the temporary Bridge Program, and why coverage could change once insurance plans become involved in 2027. The episode also outlines the role of the proposed Treat and Reduce Obesity Act and why long-term Medicare coverage still depends on congressional action.If you or a loved one are on Medicare and curious about access to GLP-1 medications for obesity treatment, this episode explains the key timelines, eligibility criteria, and practical steps patients should take with their doctors.Visit TRYSHED.COM to learn more today! Use CODE OTP25 to save 25%!
After the President's State of the Union address, Rep. Josh Gottheimer (D-New Jersey) discusses his party's response to the lengthy speech and underscores the affordability crisis facing many Americans. CNBC's Eamon Javers recaps the evening's highlights, including moments of partisan- and bipartisanship. Then, Centers for Medicare and Medicaid Services administrator Dr. Mehmet Oz discusses the administration's push to lower drug prices. Plus, Anthropic has changed its safety policy. Rep. Josh Gottheimer - 21:28 Dr. Mehmet Oz - 29:44 In this episode: Josh Gottheimer, @RepJoshG Dr. Mehmet Oz, @DrOz Eamon Javers, @eamonjavers Joe Kernen, @JoeSquawk Becky Quick, @BeckyQuick Andrew Ross Sorkin, @andrewrsorkin Cameron Costa, @CameronCostaNY Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
After Minnesota's widespread pandemic-era fraud took center stage, federal officials have ramped up efforts to uncover similar schemes nationwide—specifically targeting stolen taxpayer funds within the healthcare industry. Dr. Mehmet Oz, Administrator of the Centers for Medicare and Medicaid Services, joins us to discuss his mission to root out healthcare fraud and explain how systemic corruption is impacting the most vulnerable citizens. He details how the administration is leveraging new technology to shut down hundreds of fraudulent businesses and implementing a new strategy to ensure stricter oversight of the healthcare industry.Americans are reportedly projected to wager a record $1.7 billion on this year's Super Bowl as legalized sports betting expands to nearly 38 states. Safer Gambling Strategies President Keith Whyte joins the Rundown to discuss the "seductive logic" of prop bets, the risks of unregulated prediction markets, and how parents can talk to their children about the dangers of gambling addiction. Plus, commentary by FOX News contributor, Joe Concha. Learn more about your ad choices. Visit podcastchoices.com/adchoices
Medicare and Medicaid fraud. California healthcare corruption. Constitutional crisis. California is now being called the epicenter of Medicare and Medicaid fraud, with billions of taxpayer dollars allegedly lost to fake patients, phantom billing, and sham hospice operations. In this full podcast episode, Dr. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services explains why Los Angeles has become ground zero for healthcare fraud and how these schemes drain public healthcare programs meant to serve real patients. Dr. Oz alleges that organized fraud networks are exploiting Medicare and Medicaid at massive scale. Gavin Newsom denies the claims, accusing Oz of exaggeration and discrimination — escalating the conflict into a political and legal firestorm. This episode then turns to a second crisis: federal law vs state and city governments. Across blue cities, police departments are ordered to monitor and film ICE agents, federal officers are barred from city property, and taxpayer funds are used to oppose federal immigration enforcement. Is this lawful protest — or obstruction of federal authority? Constitutional attorney Josh Hammer breaks down: • The Supremacy Clause of the U.S. Constitution • When state resistance becomes unconstitutional • The legal implications of **Don Lemon arrest • What legal remedies exist to restore order without destabilizing the country This episode covers Medicare fraud, Medicaid abuse, California corruption, federal vs state power, ICE enforcement, constitutional law, and government overreach — with facts, legal analysis, and real consequences. Learn more about your ad choices. Visit megaphone.fm/adchoices
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