Podcasts about medicaid services cms

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

Jacob Shiff, chief AI and technology officer at the Centers for Medicare and Medicaid Services Innovation Center (CMMI), joins Josh Israel, MD, and Sean Cavanaugh to dive deeper into the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model. The model focuses on improving patient outcomes while encouraging clinicians to utilize technology-enabled solutions to deliver personalized, preventive care to those with chronic conditions, like hypertension and diabetes. Shiff shares that the goal is to give primary care physicians more support, while offering patients affordable and convenient care options. With continuous advancements with artificial intelligence (AI) and technology, Shiff hopes the ACCESS model will allow clinicians to use these advances to better engage with patients to improve outcomes. The Centers for Medicare and Medicaid Services (CMS) has extended the ACCESS application deadline to May 15: https://www.cms.gov/priorities/innovation/innovation-models/access Learn more about Aledade's participation in ACCESS: https://aledade.com/newsroom/aledade-news/aledade-joins-cms-access-model

On this week's episode of the ACB Advocacy Update, Claire speaks with Jason Eckert from VisionServe Alliance about a meeting they both attended with the Centers for Medicare and Medicaid Services (CMS). The meeting brought together numerous blindness advocates to call for the rescission of a long lasting agency policy that prevents Medicare recipients from receiving coverage to purchase assistive technology with lenses.

 Dr. Mehmet Oz, who serves as the Administrator for the Centers for Medicare & Medicaid Services (CMS), appeared on Donald Trump Jr.'s podcast Triggered for an episode titled "Following the Healthy Brick Road," where he made the disclosure that Donald Trump thinks that diet soda kills cancer. He'll hit the red button and in comes the diet soda pop, which is -- your dad argues that diet soda is good for him because it kills grass if you pour it on grass, so therefore it must kill cancer cells inside the body." President Trump thinks soda kills cancer cells, Dr. Oz says.Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Federal and state authorities report investigating hospice and home health care fraud in California, primarily involving Medicare and Medicaid billing. A federal anti‑fraud task force, formed in mid‑March, is described as coordinating with the Centers for Medicare & Medicaid Services (CMS) to identify providers showing indicators of improper billing. According to figures cited, hundreds of hospice providers and several dozen home health agencies in California have had payments suspended while investigations are ongoing, involving an estimated hundreds of millions of dollars in suspended or questioned claims. A significant portion of the flagged providers are located in Los Angeles County, with authorities citing patterns such as unusually high billing volumes, shared addresses among many licensed hospices, and lack of evidence of active operations. Law enforcement actions mentioned include search warrants, arrests, and criminal charges against individuals accused of submitting fraudulent claims for hospice services that were allegedly unnecessary or not provided. Investigators allege some schemes involved: Enrolling beneficiaries who did not meet hospice eligibility criteria Billing for “phantom” patients or services Using stolen or improperly obtained personal information Operating multiple hospice entities from the same physical location California state officials and the state Department of Justice are reported to be conducting hundreds of active investigations, sometimes in coordination with federal agencies such as the FBI and CMS. State audits and prior investigations had previously flagged weaknesses in licensing oversight, including multiple providers sharing addresses, insufficient inspections, and limited enforcement capacity. Proposed or mandated regulatory reforms discussed include: Enhanced background checks for hospice operators Restrictions on multiple hospice licenses at a single address Increased on‑site inspections Stronger pre‑licensing verification requirements Please Hit Subscribe to this podcast Right Now. Also Please Subscribe to the The Ben Ferguson Show Podcast and Verdict with Ted Cruz Wherever You get You're Podcasts. And don't forget to follow the show on Social Media so you never miss a moment! Thanks for Listening X: https://x.com/benfergusonshowYouTube: https://www.youtube.com/@VerdictwithTedCruzSee omnystudio.com/listener for privacy information.

Tap the link to hear how Senior Citizens in Louisiana and nationwide will see a win in 2027 thanks to the Centers for Medicare and Medicaid Services (CMS) has agreed to a 2.48 percent rate increase, a win for 35 million Americans who rely on health programs and their families.  For seniors and patients with disabilities who depend on Medicare Advantage, the change in the rate means seniors who rely on MA benefits and supplemental services can continue to count on them.  

Dr. Jenna Skowronski, Dr. Shazli Khan, and Dr. Alix Barnes discuss the involvement of palliative care throughout the heart failure spectrum with Dr. Sarah Chuzi. Audio editing for this episode was performed by CardioNerds Intern, Dr. Julia Marques Fernandes. In this episode, we discuss utilizing palliative care principles while caring for patients with heart failure, particularly those being considered for advanced therapies. We emphasize utilization of communication frameworks when discussing prognosis and making decisions on pursuing therapies such as palliative inotropes, left ventricular assist devices (LVADs), and heart transplant. Additionally, we discuss when to involve specialty palliative care services. Finally, we highlight the difference between palliative care and hospice and how to help patients navigate the transition from life-prolonging care to hospice. Dr. Jenna Skowronski is the Chair for the CardioNerds Heart Failure Council. Dr. Jenna Skowronski and Dr. Shazli Khan are the Co-chairs for the CardioNerds Advanced Heart Failure Therapies Series. Dr. Alix Barnes is the CardioNerds FIT Ambassador at UPMC and member of the CardioNerds Critical Care Cardiology Council. Enjoy this Circulation Paths to Discovery article to learn more about the CardioNerds mission and journey. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscripts here. CardioNerds Heart Success Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Primary palliative care is care provided by a clinician that is not a palliative care specialist, such as a heart failure clinician having a conversation with a patient about their goals and values in clinic.  Taking time to get to know a patient as an individual and learning their goals and values prior to diving into conversations about prognosis and change in treatment plan facilitates more effective goals of care discussions.   Utilizing and practicing a communication framework can improve our skills at goals of care discussions.   Palliative inotropes should be reserved for patients experiencing symptomatic benefit from the therapy that outweighs the associated risks including arrhythmias and infections. The burden of managing these therapies at home should also be considered. Partnerships between cardiologists and hospice agencies can improve the experience for patients with heart failure who enroll in hospice. Cardiologists can continue to see their patients even after hospice enrollment and help with symptom management.   Notes Notes: Notes drafted by Dr. Barnes. 1. What is the difference between primary palliative care and specialty palliative care? Primary palliative care is the delivery of palliative care services that any clinician can deliver. This includes aligning treatment with a patient's goals and basic symptom management. For heart failure patients, symptom management can include cardiac symptoms such as dyspnea and chest pain as well as managing comorbid mood disorders such as adjustment disorder, depression, and anxiety. Advanced palliative care skills take additional training and time to develop. These include leading a difficult family meeting, managing symptoms that are not controlled with standard therapies and responding to emotional and spiritual distress. When these situations are encountered, referral to a specialty palliative care service should be considered. 1 2. How is palliative care integrated throughout the disease trajectory of a patient with heart failure? Heart failure clinicians deliver primary palliative care when assessing a patient's preferences, goals and values or managing symptoms. As a patient's disease progresses, the heart failure team also engages in primary palliative care when delivering news about prognosis. When advanced therapies are being considered, utilization of shared decision-making (SDM) should be employed (see question 3 for further discussion on SDM). For patients being considered for LVAD, the Centers for Medicare and Medicaid Services (CMS) mandates that patients are seen by a palliative care specialist prior to implantation. 2 Despite this, there remains variability in how institutions involve specialty palliative care in this decision-making process. Thoughtful consideration of what palliative care resources are available at your institution should guide how best to integrate specialty palliative care teams into the LVAD decision tree. One example of a model for meeting this mandate is having a small team of heart failure clinicians with additional palliative care training meet all patient's being evaluate for LVAD. 3. What is shared decision-making (SDM) and how is it utilized when evaluating a patient for advanced therapies? SDM is a collaborative process where patients and clinicians work together to make medical decisions that are aligned with a patient's goals and values.3 There are a variety of communication frameworks that can be used to engage in effective SDM. One framework is the Serious Illness Conversation guide. This is an evidenced based framework that can be used to deliver the news about a patient's current condition and then assess their goals, values and preferences for next steps in their treatment plan.4  This framework can be helpful when discussing prognosis prior to introducing the idea of an evaluation for advanced therapies. REMAP is a second commonly used framework which stands for Reframe, Expect Emotion, Map What's Important, Align, and Plan.5 This framework is similarly helpful when starting a discussion about advanced therapies with a patient. Both frameworks prioritize learning about a patient's goals, values, and preferences prior to making a recommendation for a treatment plan. Listening more than speaking and accepting that a patient and their family may choose a path that is different than what you personally might choose for yourself or your loved ones are vital pillars to engaging in these conversations effectively. When discussing LVAD, it is important to avoid framing the decision as “LVAD or no LVAD,” rather LVAD versus best supportive care. The “Best Case, Worst Case” framework is an effective way to create choice awareness for patients when they are faced with making this decision. This is a way to discuss both the best outcomes after LVAD implantation as well as the potential complications so a patient is better able to understand the full spectrum of possible outcomes. 6 4. How do you select which patients would benefit from home inotrope therapy? There is no data demonstrating a survival benefit with use of palliative inotropes. There may be subsets of patients who derive a survival benefit, such as patients whose renal function worsens when the agent is withdrawn, however there is no concrete data proving this. 7 Therefore, the benefit of home inotrope therapy should be based on if the patient derives symptomatic benefit from these agents. Additionally, risks of the therapy such as arrhythmias and infection as well as the burden of managing these therapies at home should also be weighed in the decision.8 Life expectancy for patients being initiated on palliative inotropes likely ranges from 6 to 9 months. Given this prognosis, concordant palliative care efforts should be intensified when starting patients on these agents. This can either be through involvement in specialty palliative care or increasing primary palliative care interventions. 9 5. How do you determine if a patient would be a candidate for hospice and how do you discuss hospice with patients and their families? Hospice is a comprehensive program that provides supportive care to patients at end of life. This includes a team of physicians, nurses, aids, social workers and chaplains that can deliver care in the home, at a nursing facility, or in an inpatient hospice facility. 10 Patients with a prognosis of 6 months or less can qualify for hospice services. Even if a patient qualifies for hospice based on their prognosis, it is important to assess if a patient's goals and values align with hospice. Introducing hospice to patients who still desire life prolonging care can cause mistrust between the patient and their health care team. When introducing hospice, it is helpful to describe the services hospice offers in addition to naming the service as some patients may have a negative connotation with the word “hospice.” 6. How can cardiologists partner with hospice agencies to provide better care for these patients? Heart failure specialists can continue to see their patients even after they enroll in hospice. Partnering in hospice agencies in this way can help improve symptom management for patients while also allowing them to continue meaningful relationships with providers with whom they've developed a longitudinal relationship with. Guideline directed medical therapy (GDMT) and diuretics can be continued while enrolled in hospice as long as they are offering symptomatic benefit. Heart failure specialists can help with adjusting GDMT to cheaper formulations, such as exchanging angiotensin receptor-neprilysin inhibitors (ANRIs) for angiotensin receptor blockers (ARBs). Many hospice agencies cannot accept patients receiving palliative inotropes due to the resources and training required to safely care for these patients. Understanding what hospice agencies in your area can and cannot support allows heart failure specialists to have informed discussions with patients and make appropriate referrals. References Quill TE, Abernethy AP. Generalist plus Specialist Palliative Care — Creating a More Sustainable Model. N Engl J Med. 2013;368(13):1173-1175. doi:10.1056/NEJMp1215620. https://www.nejm.org/doi/full/10.1056/NEJMp1215620 Ventricular Assist Devices for Bridge-to-Transplant and Destination Therapy. Published online August 1, 2013. https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=Y&NCAId=268 Godfrey S, Barnes A, Gao J, Katz JN, Chuzi S. Shared Decision-making in Palliative and End‑of‑life Care in the Cardiac Intensive Care Unit. US Cardiol Rev. 2024;18:e13. doi:10.15420/usc.2024.03. https://pubmed.ncbi.nlm.nih.gov/39494405/ Baxter R, Pusa S, Andersson S, Fromme EK, Paladino J, Sandgren A. Core elements of serious illness conversations: an integrative systematic review. BMJ Support Palliat Care. 2024;14(e3):e2268-e2279. doi:10.1136/spcare-2023-004163. https://pmc.ncbi.nlm.nih.gov/articles/PMC11671901/ Childers JW, Back AL, Tulsky JA, Arnold RM. REMAP: A Framework for Goals of Care Conversations. J Oncol Pract. 2017;13(10):e844-e850. doi:10.1200/JOP.2016.018796. https://ascopubs.org/doi/10.1200/JOP.2016.018796 Kruser JM, Nabozny MJ, Steffens NM, et al. “Best Case/Worst Case”: Qualitative Evaluation of a Novel Communication Tool for Difficult in-the-Moment Surgical Decisions. J Am Geriatr Soc. 2015;63(9):1805-1811. doi:10.1111/jgs.13615. https://pmc.ncbi.nlm.nih.gov/articles/PMC4747100/ Tolia S, Khan M, Khan S, et al. Mortality and long-term outcomes of palliative inotropes in ischemic and non-ischemic cardiomyopathy. Eur Heart J.  2021;42(Supplement_1):ehab724.0915. doi:10.1093/eurheartj/ehab724.0915. https://academic.oup.com/eurheartj/article/42/Supplement_1/ehab724.0915/6392681 Chuzi S, Allen LA, Dunlay SM, Warraich HJ. Palliative Inotrope Therapy: A Narrative Review. JAMA Cardiol. 2019;4(8):815. doi:10.1001/jamacardio.2019.2081. https://jamanetwork.com/journals/jamacardiology/article-abstract/2737414#google_vignette Chuzi S, Gao J, Thariath J, et al. Characteristics and Outcomes of Palliative Continuous Intravenous Inotrope Support Among Medicare Beneficiaries With Heart Failure. J Am Heart Assoc. 2025;14(14):e039397. doi:10.1161/JAHA.124.039397. https://www.ahajournals.org/doi/10.1161/JAHA.124.039397 What is hospice? Published online September 24, 2024. https://hospicefoundation.org/what-is-hospice/

PerfWeb 111 Day 1 assesses the potential effects of Centers for Medicare and Medicaid Services (CMS) payment policies on perfusionist compensation within hospital systems. This session examines how annual updates to inpatient prospective payment systems and quality-based adjustments constrain hospital budgets, indirectly shaping salary structures and staffing models for cardiovascular perfusion teams. For perfusion leaders, it provides a framework for anticipating fiscal shifts and advocating for sustainable compensation in an era of value-based care. Learning Objectives: Explain the mechanisms of CMS hospital payment systems, including diagnostic-related groups (DRGs) relevant to cardiac procedures. Identify key changes in recent CMS rules that impact reimbursement for perfusion-supported surgeries like coronary artery bypass grafting. Evaluate how hospital revenue pressures from CMS adjustments affect perfusion department budgets and compensation packages. Differentiate between direct and indirect influences of CMS policies on perfusionist salaries, benefits, and on-call stipends. Apply strategies for perfusion services to demonstrate value through cost-efficiency metrics and quality outcomes. Assess negotiation tactics for perfusion contracts in light of hospital fiscal constraints driven by CMS. Develop a plan to monitor upcoming CMS proposals and adapt perfusion practice models accordingly.

Send us Fan MailThe Centers for Medicare and Medicaid Services (CMS) just finalized rules to update attachment requirements for sending with insurance claims.  The Divas discuss when these rules became final and the specific requirements of these new rules that apply to dental practices.Resources:Federal Register - Final Rule Administrative Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures https://bit.ly/4m5u5gl The HIPAA Journal - CMS Releases Final Rule Implementing HIPAA Standards for Health Care Claims Attachments https://bit.ly/4tnblvg                                                   https://www.thecompliancedivas.com

In 2025, the Centers for Medicare and Medicaid Services (CMS) began requiring hospitals participating in the Hospital Inpatient Quality Reporting (IQR) program to report on a new "Age-Friendly Hospital Measure."  The hope is that, by attesting to this measure, hospitals will develop evidence-based processes to improve care for older adults in hospital settings. On this week's podcast, we explore this new measure with Sheri Ling, CMS's Deputy Chief Medical Officer serving in the Center for Clinical Standards and Quality (CCSQ). We've also invited some returning guests from our past Age Friendly Health Systems podcast, Julia Adler-Milstein and Stephanie Rogers, to discuss how they are thinking about this new measure and how we should operationalize it. We go over everything you will want to know about the new measure, including: How does this CMS measure differ from both Age-Friendly Health Systems and the 4Ms movement we've been hearing about for years (and that we did the podcast on in 2020 here) Why is CMS finally making "Age-Friendly" a formal, structural requirement for hospitals now? What is an attestation measure vs outcome measure, and why is this one an attestation measure? A deeper dive into the 5 domains to the measure (Eliciting Patient Goals, Medication Management, Frailty Screening, Social Determinants of Health, and Leadership/Governance. Lastly, here are some great resources if you want to help get this started at your hospital: A report by JAHF, Julia and others on how to think about different dimensions of measure performance Health Affairs Scholar paper on related the 4Ms to the 5 domains Two CMS resources with detailed information on how to meet and report on the five domains of this measure: Age-Friendly Hospital Specifications (July 2025) Age-Friendly Hospital Measure Attestation Guide  

In this episode of the 20-Minute Health Talk podcast, Abe Sutton of the Centers for Medicare & Medicaid Services (CMS) joins host Chethan Sathya, MD, to share his personal path into public service and the lessons that shaped his approach to health policy. Sutton breaks down how CMS is tackling rising medical costs while raising the quality of care, covering value-based care models, payment reforms that reward outcomes over volume, and efforts to reduce administrative burden and improve care coordination. This is Part 1 of this series. Listen to Part 2 About Northwell Health 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. For information on our more than 100 medical specialties, visit Northwell.edu and follow us @NorthwellHealth on Facebook, Instagram, X and LinkedIn. 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 more 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. 

In part 2 of this 20-Minute Health Talk podcast with Abe Sutton of the Centers for Medicare & Medicaid Services (CMS), and host Chethan Sathya, MD, discuss data-driven innovation, primary care investment, and strategies to enhance the patient experience without sacrificing affordability. Given CMS's budget, Sutton talks about the need for investment in evaluating quality, outcomes, and new approaches to delivering care.  This is Part 2 of this series. Listen to Part 1 About Northwell Health 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. For information on our more than 100 medical specialties, visit Northwell.edu and follow us @NorthwellHealth on Facebook, Instagram, X and LinkedIn. 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 more 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. 

Prosecutors in South Dakota have dismissed charges against an Indigenous rights advocate. South Dakota Public Broadcasting’s CJ Keene reports. Charges stemming from a 2022 incident against Nick Tilsen, CEO and founder of NDN Collective, were dropped. In a statement, Tilsen said, “my freedom wasn't granted by a judge, a jury, or the settler colonial court system. My freedom was won by the people, the movement, and the ancestors.” Tilsen faced more than 25 years in prison, originally facing charges of aggravated assault on a law enforcement officer and obstruction. Ultimately, the trial resulted in a hung jury. Tilsen maintained his innocence throughout, saying the incident was an effort to watch an interaction between police and an Indigenous member of the Rapid City, S.D. community. NDN Collective spokespeople had contended the charges were excessive. In the same statement, representatives describe them as, “blatantly politically motivated effort to silence a movement leader by criminalizing his actions.” In response, Pennington County State's Attorney said, “the decision to dismiss this case was made after careful review and thoughtful consideration.” The office adds they stand by the charging decision. “While we believe the case was properly charged and presented, the jury's inability to reach a verdict was an important factor in evaluating whether further prosecution would serve the interest of justice.” A nearly empty critical care unit at Bartlett Hospital on April 7, 2020, in Juneau, Alaska. (Photo: Rashah McChesney / KTOO) Alaska will receive about $1 billion from the federal government over the next few years to improve healthcare, but millions of that depends on the legislature passing several bills aligning Alaska with best practices for rural healthcare. Alaska Native people are much more likely to live in rural areas than other Alaskans. As Alaska Public Media's Rachel Cassandra reports, a proposal to make it easier for out-of-state nurses to practice in Alaska is facing fierce pushback. When you boil it down, Alaska Hospital and Healthcare Association head Jared Kosin says joining a so-called license compact is pretty simple. He says there would be a set of criteria nurses would demonstrate. “And if they do, then they are issued a license and then they can practice in any states that use those same standards.” Proponents say joining a compact would help ease a nurse shortage across the state that is projected to worsen. Kosin says it may be simple to explain, but actually getting a bill passed to join the nurse licensure compact has been anything but. “It’s just so snagged up in politics.” The last version of the bill was introduced in 2023. It was supported by most healthcare organizations in the state, but it was opposed by nursing unions. He says that created a toxic dynamic. And this year there is new pressure on the legislature thanks to the Rural Health Transformation Program. When the Alaska Department of Health (DOH) applied for the money, it told the Centers for Medicare & Medicaid Services (CMS) the state would join the compact. The state has been directed by CMS to create compacts for other health care positions too: physicians, emergency medical services, psychologists, and physician assistants. The DOH does not know exactly how much money would be clawed back if Alaska does not pass all the required legislation, but a DOH official wrote over email that a ballpark estimate is that millions of dollars is at stake annually and tens of millions of dollars over the five years of rural funding. Shannon Davenport is a union leader and a nurse. She says there are many problems with the nursing field right now, especially workplace safety, and she doesn't think the nursing compact is the solution to them. “It’s not the golden goose. It’s not the answer to everything.” Even so, most nurses support a compact — almost 90% of nurses living in Alaska, according to a 2023 survey. The federal deadline to join the compact is at the end of 2027. Get National Native News delivered to your inbox daily. Sign up for our daily newsletter today. Download our NV1 Android or iOs App for breaking news alerts. Check out today’s Native America Calling episode Tuesday, March 17, 2026 – Re-enactors help bring Native American perspective of the Revolutionary War to life

Hosts Megan Beaver and Savanna Williams talk to Rachel Park and Lisa Umans about the regulation of the organ procurement industry, recent congressional interest in the space, and the latest updates from the Centers for Medicare and Medicaid Services (CMS).  This podcast episode features the following speakers: Rachel Park is a senior counsel in Crowell & Moring's Washington, D.C. office and a member of the firm's Health Care Group. She advises clients on a wide array of health care matters, including Medicare and Medicaid reimbursement, managed care litigation, and health care fraud investigations and oversight. Prior to joining Crowell, she served for 24 years at the U.S. Department of Health and Human Services (HHS), most recently as principal deputy general counsel, the highest-level nonpolitical appointee in the HHS Office of the General Counsel.  Lisa Umans is a partner in Crowell & Moring's New York office and a member of the firm's White Collar and Regulatory Enforcement group and Financial Services group. She represents large institutional clients and individuals in federal and state regulatory and criminal investigations conducted by grand juries, congressional committees, and domestic and international law enforcement and regulatory agencies including the Department of Justice's Criminal and Antitrust Divisions, U.S. Attorney's Offices, Securities and Exchange Commission (SEC), the Commodity Futures Trading Commission (CFTC), the Financial Industry Regulatory Authority (FINRA), and various State Attorneys General. Payers, Providers, and Patients – Oh My! is Crowell & Moring's health care podcast, discussing legal and regulatory issues that affect health care entities' in-house counsel, executives, and investors.

In this episode of #TheShot of Digital Health Therapy, my regular co-host Jim Joyce passed the bouton to Daniel Kendall who was kind enough to step in. Dan and I sat down with Margaret Moore aka Coach Meg. As the founder of Wellcoaches and the co-founder of the Institute of Coaching as well as National Board for Health & Wellness Coaching, she pioneered the professional standards for health & wellbeing coaching. As we always say.... to be a Key Opinion Leader (KOL) you need to have opinions AND backed by data! Meg brings it all to our discussion: -Why telling people what to do is the least effective way to change them. -The Science of Coaching: How Margaret shepherded coaching from a "soft skill" to a science-backed discipline. -Using "Parts Work" to navigate the voices in our heads that resist change. -Human-Centered AI: Why healthcare needs a "coaching chip" inside the machine. -Will Centers for Medicare & Medicaid Services (CMS) adopt coaching as part of the chronic disease management framework? If you're trying to move the needle on patient outcomes, Margaret explains why the relationship is the medicine. Links in comments. Fun mentions as always: Ruth Q. Wolever, PhD, NBC-HWC Gary Sforzo Marina Borukhovich Dr Mehmet Oz, RFK Jr. 04:30 – The Business vs. The Creative: How Margaret transitioned from Biotech C-Suite to "Coach Meg." 17:00 – Professionalizing Coaching: Building the Institute of Coaching and the NBHWC standards. 23:15 – The CMS Update: Framing coaching for Medicare coverage and the "dose response" of behavior change. 34:10 – The Paradigm Shift: Why the Annual Wellness Visit needs to start with "What are your health goals?" 45:30 – Mapping the Mind: Using biology to create a unified framework for the human psyche. 51:20 – The 15-Year-Old Self: A personal revelation on reclaiming flow and leadership.

The Centers for Medicare & Medicaid Services (CMS) has launched a new initiative titled Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH).CRUSH is a sweeping fraud prevention program. In an official news release posted Thursday, CMS reported suspending $5.7 billion in suspected fraudulent Medicare payments, preventing $1.5 billion in DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) billing, revoking more than 5,500 providers' billing privileges, and denying 122,000 claims that failed medical necessity checks.This latest news, including a nationwide DMEPOS enrollment moratorium and a $259.5 million Medicaid funding deferral, signals a decisive shift toward real-time enforcement.What does CRUSH mean for providers, revenue cycle leaders, and compliance teams?Senior healthcare consultant Penny Jefferson will be the special guest during the next live edition of the long-running news and information national podcast Monitor Mondays. Jefferson, the director of clinical documentation integrity (CDI) services for the University of California Davis Medical Center, will report on this new and developing story.The broadcast will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.Legislative Update: Adam Brenman, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

In a January 28 article, Dr. Ronald Hirsch verified that the Centers for Medicare and Medicaid Services (CMS) “has no problem” with the Aetna Severity Payment policy because it “meets the Two-Midnight Rule.” However, there is more to consider than compliance with 42 CFR 412.3. Federal regulations also state Medicare Advantage organizations must comply with Traditional Medicare laws including payment criteria for inpatient admissions at 42 CFR 422.101(b)(2). So the burning question remains: Is CMS disregarding pertinent regulations that could nullify Aetna's policy?During the next live edition of the venerable Monitor Monday, the Internet broadcast, Cheryl Ericson, senior director of clinical policy and education for the Brundage Group, will address this apparent contradiction.Broadcast segments will also include these instantly recognizable features:·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. ·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.·      Legislative Update: Adam Brenman, legislative affairs liaison for Zelis, will report on current healthcare legislation.

340B Insight wants to make our podcast the best it can be. To help us succeed, we'd like to hear your thoughts. Please take just a few minutes to complete our listener survey, and we will enter you in a drawing to win a $100 gift card! To participate, please go to 340bpodcast.org/survey.For the third year in a row, we consulted 340B Health's experts on our staff to answer our listeners' most pressing 340B questions. As 2026 gets underway, we answer your questions about the CMS drug acquisition cost survey, what states are doing on 340B this year, and more. Some of the topics we cover:CMS Drug Acquisition Cost Survey Not MandatoryEarlier this year, the Center for Medicare & Medicaid Services (CMS) launched a new survey focusing on hospitals' outpatient drug acquisition costs, which could lead to Medicare Part B payment cuts for 340B drugs. Some hospitals recently saw materials suggesting they are required to complete the survey. Amanda Nagrotsky, vice president of legal and policy for 340B Health, notes that a CMS rule states there are no penalties under the Medicare statute for hospitals that choose not to respond. 340B Health and other groups sent a joint letter asking for the language to be corrected, citing the confusion it has caused.State Legislatures Are Becoming Major Battlegrounds for 2026Just over one month into 2026, statehouses are already shaping up to be one of the biggest venues to debate various aspects of the 340B. Two broad categories of bills are emerging: legislation protecting access to 340B pricing — including protections for contract pharmacy arrangements — and state-level reporting mandates. 340B Health Senior Vice President of Government Relations Tom O'Donnell says the proposed reporting mandates mirror other states' recently enacted requirements, and he argues they can be misleading, burdensome, or modeled on frameworks promoted by large drug companies.Medicare Announces More Drug Price Caps for 2028Medicare is phasing in maximum fair pricing – or MFP – for high-spending drugs over several years. CMS recently announced the next group of 15 drugs that will be subject to these types of price caps in 2028, adding to the 2026 and 2027 drug lists. Starting in 2028, these price caps will apply to both Medicare Part D and Part B drugs, including those purchased through Medicare Advantage. 340B Health Senior Manager of Pharmacy Services Gilda Yeboah says this means hospitals will see reduced 340B savings on certain drugs as Medicare prices move closer to existing 340B ceiling prices. Yeboah says the issue is complex and evolving, and 340B Health is working to share concerns about MFP implementation with federal agencies.Resources340B Health and Allies Urge CMS Contractor To Correct Statement Suggesting Hospitals Must Respond to OPPS Drug Cost SurveyStates Introduce New 340B Legislation in 2026 SessionsMaine Federal Court Rejects Drug Company Challenge to State 340B Contract Pharmacy LawMedicare Expands List of Drugs Subject to Price Caps, Decreased 340B Savings Starting in 2028Manufacturer Notices to Covered EntitiesHRSA Releases 340B Purchase Data for 2024FY 2025 Manufacturer Audit Results

It's raining RACs.The Recovery Auditor Contractors (RACs), together with an alphabet soup of other private and public auditors, are coming down hard on hospitals and physician practices, looking for omissions and errors in submitted claims.Then there are seemingly contradictory rules from the Centers for Medicare & Medicaid Services (CMS).It's little wonder that providers are treading cautiously as they look to thread the needle of compliance.This coming Monday, the venerable Monitor Mondays broadcast will present a cadre of the sharpest minds in healthcare auditing. You'll hear auditing news you won't find anywhere else – just here.Broadcast segments will also include these instantly recognizable features:·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. ·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.·      Legislative Update: Cate Brantley, legislative affairs liaison for Zelis, will report on current healthcare legislation.

n the 8 AM Hour: Larry O’Connor and Patrice Onwuka discussed: WMAL GUEST: 8:05 AM - INTERVIEW - LOUDOUN COUNTY SHERIFF MIKE CHAPMAN TOPIC: Gov. Spanberger ends ICE agreement involving Virginia State Police and corrections officers WMAL GUEST: 8:15 AM - INTERVIEW - CHRIS KLOMP - Director of Medicare and Deputy Administrator of Centers for Medicare & Medicaid Services (CMS) and Senior Advisor to HHS Secretary Robert F. Kennedy Jr TOPIC: Discuss TrumpRX announcement yesterday WMAL GUEST: 8:35 AM - INTERVIEW - KATIE PAVLICH - host of NewsNation's Katie Pavlich Tonight TOPIC: Discuss news of the day / plug her new show Sean Spicer on X: "This is Virginia Attorney General Jay Jones’ parking spot on Grace Street in downtown Richmond Apparently when you threaten your political opponent with “two bullets to the head” they make it a gun free zone https://t.co/Zy8OPnQl7E" / X Where to find more about WMAL's morning show: Follow the Show Podcasts on Apple podcasts, Audible and Spotify. Follow WMAL's "O'Connor and Company" on X: @WMALDC, @LarryOConnor, @Jgunlock, @patricepinkfile and @heatherhunterdc. Facebook: WMALDC and Larry O'Connor Instagram: WMALDC Show Website: https://www.wmal.com/oconnor-company/ How to listen live weekdays from 5 to 9 AM: https://www.wmal.com/listenlive/ Episode: Friday, February 6, 2025 / 8 AM HourSee omnystudio.com/listener for privacy information.

There was a time when Relative Value Units (RVUs) felt like a stable currency – something you and others could take to the bank. That was then. This is now.Then, productivity could be measured, compensation plans could be managed, and economic models could assume relative stability in physician work measurement.Recently, actions by the Centers for Medicare & Medicaid Services (CMS) – culminating in the 2026 Physician Fee Schedule – signal a philosophical shift in how physician work is valued, adjusted, and used as a policy lever. The takeaway is not that RVUs are broken; it is that they are no longer designed to be static. For more details on this change, the producers of Monitor Mondays have invited senior healthcare analyst Frank Cohen to be the special guest during the next live edition of the venerated Internet broadcast, coming up on Monday, Feb. 2.Broadcast segments will also include these instantly recognizable features:·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. ·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.·      Legislative Update: Matthew Albright, chief legislative affairs liaison for Zelis, will report on current healthcare legislation.

Andy Cumpstey takes the chair to speak with Professor Lee Fleischer, Emeritus Professor of Anesthesia and Critical Care at the University of Pennsylvania and the former Chief Medical Officer and Director of the Centers for Medicare and Medicaid Services (CMS), U.S. Department of Health and Human Services. Lee shares his remarkable journey, from his early interest in science and medicine to his pivotal roles in clinical research, healthcare policy, and national advisory boards. He discusses his efforts during the COVID-19 pandemic, the importance of balancing professional commitments with family life, and his ongoing passion for advancing evidence-based perioperative practice. The conversation also explores his work with the CMS, contributions to healthcare policy, and his future aspirations. -- Super Early Bird registration is now open for The Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London, but it ends on 31 January! We are right now offering the best available rates to attend the Congress. We encourage you to register early and take advantage of this opportunity while you still can. Register here - https://ebpom.org/product/ebpom-world-congress-2026/

Learn more about the Medicare prescription payment plan program. Get the information you need now so you can answer questions from your clients.  

“Minnesota … is just the tip of the iceberg,” says Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services (CMS).Minnesota has become the epicenter of several overlapping fraud investigations of childcare programs, small business pandemic loans, and Medicaid services. Earlier this month, Dr. Oz traveled to Minnesota to tour suspected fraud sites and meet with whistleblowers and announced that over $2 billion in annual Medicaid funding might be withheld.“What we're seeing in Minnesota, which is billions of dollars of fraud that hurts our most vulnerable people and puts them at risk … is dwarfed by what I saw in California, which is whole-scale cultural malfeasance around health care,” Dr. Oz says.“The magnitude of fraud there, we believe, is approximating $4 billion just in hospice and home health care,” he says.Dr. Oz oversees programs that together constitute about one-fourth of the entire U.S. federal budget.In this episode, he breaks down how the home health care and hospice systems are being exploited on a massive scale and also how Medicare beneficiary numbers are being stolen and weaponized for fraudulent billing schemes.As the administration approaches its one‑year mark, he reflects on efforts to cut waste, lower drug prices, and transform health in America.President Donald Trump has recently unveiled his new “Great Healthcare Plan” to lower prices and increase transparency.“For decades, Americans have been paying three times more than Europeans and other developed nations have been paying for the exact same drugs made in the same facilities,” Dr. Oz says.Views expressed in this video are opinions of the host and the guest, and do not necessarily reflect the views of The Epoch Times.

Health Affairs' Jeff Byers is joined by Michael Chernew from Harvard Medical School to explore the recent 2024 health care spending report from the Centers for Medicare and Medicaid Services (CMS).To kick off the new year, we are offering podcast videos of A Health Podyssey. Subscribe to our YouTube channel to watch those episodes. Let us know what you think about the videos by emailing us at communications@healthaffairs.org.Join us on January 21 for an exclusive Insider virtual event exploring the latest drug policies with the University of Utah's Joey Mattingly. Become an Insider to get access to this event.Related Articles:National Health Care Spending Increased 7.2 Percent In 2024 As Utilization Remained Elevated (Health Affairs)Growth In National Health Expenditures: It's Not The Prices, Stupid (Health Affairs Forefront)

Welcome to a special episode of HME News in 10, sponsored by DDP Medical Supply.  Today's guest, Brian O'Neill, president of DDP Medical Supply, says providers of continuous glucose monitors (CGMs) are at a fork in the road.  With the Centers for Medicare & Medicaid Services (CMS) adding CGMs to the next round of the Medicare competitive bidding program, providers must choose:  • Step away before bidding begins; or  • Scale up to compete for one of the limited contracts  O'Neill shares why DDP is focused on partnering with those aiming to win – and how its expanded distribution network and other upcoming initiatives are designed to help providers deliver nationwide efficiently and economically.  Hosts:  Liz Beaulieu  Theresa Flaherty  Guest:  Brian O'Neill 

The Centers for Medicare & Medicaid Services (CMS) will block hospitals from performing certain interventions that are intended to change a child's physical appearance to align an asserted sex identity.Reporting the lead story during the next live edition of Monitor Mondays will be independent physician consultant Dr. Drew Updike.More than four weeks since its last news broadcast, Monitor Mondays will return this coming Monday, Jan. 12, with a cadre of the smartest minds in healthcare auditing. You'll hear auditing news you won't find anywhere else – except here the RACmonitor.Broadcast segments will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.Legislative Update: Matthew Albright, chief legislative affairs liaison for Zelis, will report on current healthcare legislation.

Host Dr. Jay Anders welcomes back Amy Gleason, Acting Administrator of the U.S. DOGE Service and Strategic Advisor to the Centers for Medicare & Medicaid Services (CMS). Together they discuss healthcare data interoperability challenges and CMS's initiatives, including efforts to modernize systems and combat Medicare fraud through enhanced data access and AI implementation. This is a must-listen for anyone in health tech. 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/

This week on Minnesota Military Radio, we host our annual Minneapolis VA Health Care System 2025 year in review. The episode covers major accomplishments from the past year, including earning a second consecutive 5-star rating from the Centers for Medicare & Medicaid Services (CMS). This top honor recognizes outstanding quality care, placing the Minneapolis VA […] The post Minneapolis VA 2025 Year in Review appeared first on Minnesota Military Radio.

In this episode of the Advancing Surgical Care Podcast, ASCA Chief Executive Officer Bill Prentice and ASCA Chief Advocacy Officer Kara Newbury discuss the 2026 final payment rule for ASCs released by the Centers for Medicare & Medicaid Services (CMS) on November 21. The 1,657-page rule establishes the inflation update for Medicare payments to ASCs, the expanded list of surgical codes that can be performed on Medicare beneficiaries in the ASC setting, significant changes to the ASC Quality Reporting Program and more. Prentice and Newbury break it all down in less than 20 minutes, providing essential guidance, information and resources for Medicare-certified ASCs in the year ahead.

The Centers for Medicare & Medicaid Services (CMS) recently released the 2026 Medicare Physician Fee Schedule. And while that's not breaking news, the important news is that you and your team could benefit by understanding its hidden traps – so you can protect your revenue. During the next live edition of Monitor Monday, senior healthcare analyst Frank Cohen will reveal the latest developments in Medicare audit reforms and statistical extrapolation, including the Medicare Program Integrity Manuel (MPIM) standards, plus how artificial intelligence (AI) is changing audit selection for 2025.You and your team will receive expert analysis and practical guidance, as well as gain a better understanding of the true scope of improper payments.The weekly broadcast will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.Legislative Update: Adam Brenman, senior healthcare legislative affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Between new developments on a rebate pilot program, discussions of possible cuts to Medicare payment for 340B drugs, and new action in states nationwide, this fall has been a jam-packed season for 340B. We sit down with 340B Health President and CEO Maureen Testoni to break down the latest.Questions Remain About January's 340B Rebate Pilot After the Health Resources & Services Administration (HRSA) released 340B rebate pilot program guidance over the summer, all nine manufacturers of the 10 drugs subject to Medicare price caps applied to HRSA to implement rebates for the drugs starting in January. Testoni says we expect to find out which plans are approved in early November, as drugmakers need to give eight weeks of notice so covered entities can prepare for the change. Testoni says questions remain about the rebate pilot, but information that the drugmakers' rebate vendor has released so far provides enough detail for hospitals to start preparing for both rebates and price caps.Potential Medicare Cuts Expected To Target 340B HospitalsEarlier this year, the Trump administration released an executive order directing the Centers for Medicare & Medicaid Services (CMS) to survey hospitals on drug acquisition costs with the goal of using the results to set payment rates for Medicare Part B drugs starting in 2027. Testoni says she is concerned the proposed survey will lead to CMS targeting only 340B drugs for cuts that could bring payment rates down to actual acquisition costs, which would be a steeper cut than what the agency imposed during the first Trump administration.States Keep Moving on Contract Pharmacy Protections, 340B MandatesNearly 20 states have contract pharmacy protection laws in place and a small number of drugmakers have sued to block all these statutes. But Testoni says so far, courts have denied those requests and the laws have stayed in effect despite significant opposition advocacy by drugmakers. An increasing number of states also have enacted laws requiring 340B hospitals to report substantial data on their 340B costs and savings, and some are looking to limit how hospitals can use those savings.Resources:Senate Hearing Features Both Bipartisan Support for 340B and Calls for ReformsRead Our Comments on CBO's 340B Growth ReportReview Our 340B Rebate Pilot and IRA ResourcesBeacon Shares New Details on 340B Rebate Pilot Implementation

Dr. Mark McClellan has served as a Member of the President's Council of Economic Advisors, Administrator of the Centers for Medicare & Medicaid Services (CMS), and Commissioner of the U.S. Food and Drug Administration (FDA). But his experiences before, and accomplishments following these leadership roles at the highest levels of government health policy are equally important to his perspective on the healthcare ecosystem – especially during a time of rapid policy change.Dr. McClellan always intended on pursuing a medical degree and entered a joint Harvard-MIT program that took him in a slightly different direction. He ended up studying economics and the rising cost of healthcare at MIT. He ultimately earned a medical degree from the Harvard-MIT Division of Health Sciences and Technology, a Ph.D. in economics from MIT, and a master's in public administration from Harvard's Kennedy School.Dr. McClellan began his career at the Treasury Department in the Clinton Administration, and returned to public service under the George W. Bush Administration where he led the FDA and CMS. Today, Dr. McClellan is the Robert J. Margolis, M.D., Professor of Business, Medicine and Policy at Duke University and the founding Director of the Duke-Margolis Institute for Health Policy. His work centers on improving health care through policy and research, with a focus on payment reforms, quality, value, and biomedical innovation.With his expertise in medicine, economics and public policy, Dr. McClellan talked to Keith Figlioli in this episode of Healthcare is Hard to share his perspective on adapting to rapid change in the current healthcare landscape. Topics they discussed include:Misalignment of innovation and outcomes. While advancements in digital health are coming to market faster than ever before, Dr. McClellan says there's still a lack of technology truly centered on keeping patients healthy. He says traditional payment methods make it hard to support this type of innovation. For example, advancements in AI are helping physicians gather information for prior authorization requests, and ambient scribing saves time with note taking and administration. But these technologies essentially help providers see more fee-for-service patients or bill for more profitable services. He argues that more outcome-oriented payments are needed to advance technology-embedded care models. The evolution of value-based care. After Congress passed the Medicare Modernization Act in 2003 to establish Medicare Advantage, Dr. McClellan became administrator of CMS at the President's request to lead its implementation. With unique insight from leading some of the earliest VBC programs, he shared his thoughts on the speed of adoption and why it hasn't happened faster. He discussed how early MA models needed to be based on existing fee-for-service infrastructure, his surprise that not much has changed, and his optimism that it's finally starting to.Mobilizing private capital for public health. Private investment will be essential to support the significant changes required to improve healthcare – especially with uncertainties around future levels of government funding. Dr. McClellan explained how the Duke-Margolis Capital Impact Council (CIC) was launched to guide and improve the role of private investment in healthcare. He described how members of the council are developing and sharing practices for investors and their portfolio companies to track health value return on investment alongside financial ROI.To hear Dr. McClellan and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

“When you think about where we were as a country before Medicare and Medicaid were created and where we are now, it's an incredible story,” says Chiquita Brooks-LaSure, who until earlier this year was the administrator for the Centers for Medicare and Medicaid Services (CMS). In a recent essay for The Century Foundation, where she is now a senior fellow, Brooks-LaSure used the 60th anniversary of enactment of those foundational insurance programs to help put their impact on individual Americans, the healthcare system and society at large in perspective. One prominent example is the desegregation of hospitals, which was achieved in part by withholding reimbursements for care unless facilities served Blacks as well as whites. Another is making it possible for more people with disabilities to live at home instead of in institutional settings. But as you'll hear in this probing Raise the Line conversation with host Lindsey Smith, Brooks-LaSure worries that many gains in coverage and other progress made over the years through Medicare, Medicaid and the Child Health Insurance Program (CHIP) are at risk because of a new federal law that calls for a trillion dollar decrease in spending, resulting in potentially millions of people losing their coverage, cuts to clinical staff and medical services, and the closure of hospitals and clinics, especially in rural areas. “Most rural hospitals in this country are incredibly dependent on both Medicare and Medicaid to keep their doors open and there's an estimate that over 300 hospitals will close as a result of this legislation, so that, I think, is a place of incredible nervousness.” Whether you are a patient, provider, policymaker or health system leader, this is a great opportunity to learn from an expert source about the range of potential impacts that will flow from changes to critically important insurance programs that provide coverage to 40% of adults and nearly 50% of children in the U.S. Mentioned in this episode:The Century FoundationEssay on 60th Anniversary of Medicare & Medicaid If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

Healthcare compliance just shifted fundamentally.Traditional whistleblowers who needed inside access are being replaced by artificial intelligence (AI)-powered relators who mine public datasets and flag statistical anomalies that could signal fraud.The U.S. Department of Justice (DOJ) logged 979 qui tam cases in 2024, many of which were reportedly triggered by mathematical outliers, rather than insider tips. Government agencies, such as the Centers for Medicare & Medicaid Services (CMS), have already recovered $820 million using algorithmic detection.During the next live edition of Monitor Mondays, senior healthcare analyst Frank Cohen will reveal a possible solution for hospitals, health systems, and physician practices.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Medicare Advantage plans are about to face unprecedented scrutiny as the Centers for Medicare & Medicaid Services (CMS) implements a dramatically expanded approach to RADV audits. Starting in 2025, every Medicare Advantage plan will be subject to contract-level RADV audits—a significant departure from the historical approach of randomly selecting 60 plans annually. During this 17-minute podcast, Deborah Curry, risk adjustment programs director at Medical Mutual. breaks down the critical changes that compliance teams need to prepare for immediately. She offers practical strategies for surviving this new audit environment, emphasizing the importance of designated backup personnel, weekly progress huddles, and careful oversight of vendors retrieving medical records. Whether you're already facing a RADV audit or preparing for the inevitable, this episode provides essential guidance for navigating CMS' aggressive new approach. For deeper insights, join RISE in Tampa, Fla. on October 21-23 for the 26th Risk Adjustment Forum, where Curry will be sharing additional strategies for RADV readiness.About Deborah CurryDeborah Curry, risk adjustment programs director, Medical Mutual, joined Paramount Healthcare in May 2013 and oversees the Risk Adjustment, Coordination of Benefits, and Subrogation departments. Prior to her position with Paramount, she had 21 years' experience working with the State of Ohio workers' compensation program, both for the government and a contracted managed care organization. She came to Paramount with extensive knowledge in medical coding, provider billing and education, Medicare payment methodologies, quality assurance, and regulatory compliance.Curry attended The University of Toledo for both her undergraduate and graduate degrees and currently holds a Master of Business Administration with major in Healthcare Systems Management. She is an active member of the American Health Information Management Association (AHIMA) and is a Registered Health Information Administrator (RHIA) and Certified Coding Specialist, physician based (CCS-P).Curry is also an active member of the America Academy of Professional Coders (AAPC) and is a Certified Risk Adjustment Coder (CRC). She holds certificates as a Risk Adjustment Practitioner (RAP) and Advanced HCC Auditor (AHCCA and serves as a Board Member of the University of Toledo Health Information Administration Advisory Board, Health and Human Services Alumni Affiliate at The University of Toledo, and Health Information Technology Advisory Committee at Owens Community College.About the Risk Adjustment ForumRISE's Risk Adjustment Forum is designed for leaders in risk adjustment, coding, compliance, finance, and analytics across Medicare Advantage, Medicaid, Affordable Care Act, and commercial plans. The three-day event, which will take place Oct. 21-23 at the Grand Hyatt Tampa Bay, will tackle RADV audit ramp‑up and extrapolation, the Big Beautiful Bill Act, V28/RxHCC shifts, internal audit design, and CDI.   

OSF Saint Luke Medical Center in Kewanee has secured a prestigious five-star rating from the Centers for Medicare and Medicaid Services (CMS). This accolade places the hospital among an elite group recognized nationally for superior healthcare delivery. Evaluations covered key areas including patient safety, overall patient experience, and the effectiveness of medical treatments. Hospital administrators attribute this achievement to the dedication and expertise of their medical staff, as well as a continued focus on quality improvement. President Jackie Kernan and Samantha Rux joined Wake Up Tri-Counties to talk about what the award means to OSF Saint Luke.  “This recognition is a powerful testament to the exceptional talent and dedication of our team,” said Jackie Kernan, president of OSF Saint Luke. “Our caregivers are unwavering in their commitment to delivering high-quality, compassionate care. Their efforts ensure that our patients have access to health care locally, and this honor reflects our continued promise to improve the health and well-being of the community we serve.” The recognition not only boosts community confidence but also cements OSF Saint Luke's reputation as a leader in compassionate and effective care in the region.

There just might be a reign of terror being experienced at many of America's hospitals and health systems. Professionally delivered patient care apparently seems to be getting hijacked by auditors compelled to deny claims of omission.Aided by the Centers for Medicare & Medicaid Services (CMS) and abated by auditors private and public, the lingua franca appears be an entanglement of descriptors, namely “inpatient versus outpatient.”During the next live edition of the venerated Monitor Monday broadcast, several of the most recognized names in healthcare will not add to the confusion, but offer advice for those on the front lines of battle.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior healthcare government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

In this episode, Terry dives into the latest findings from the Centers for Medicare & Medicaid Services (CMS) regarding Evaluation and Management (E/M) services. According to the 2023 CERT (Comprehensive Error Rate Testing) data: Insufficient documentation led to 34% of improper payments No documentation accounted for 7.5% Incorrect coding was responsible for a staggering 52.4% […] The post CMS E/M Improper Payment Report appeared first on Terry Fletcher Consulting, Inc..

In this episode, Terry dives into the latest findings from the Centers for Medicare & Medicaid Services (CMS) regarding Evaluation and Management (E/M) services. According to the 2023 CERT (Comprehensive Error Rate Testing) data: Insufficient documentation led to 34% of improper payments No documentation accounted for 7.5% Incorrect coding was responsible for a staggering 52.4% […] The post CMS E/M Improper Payment Report appeared first on Terry Fletcher Consulting, Inc..

Although the proposed rule for the 2026 Inpatient Prospective Payment System (IPPS) has been released by the Centers for Medicare & Medicaid Services (CMS), mastering the complexities will continue to challenge most coders and coding team members. That is why ICD10monitor producers have asked Dr. James S. Kennedy to join the upcoming edition of Talk Ten Tuesdays: to highlight potentially significant roadblocks that are likely to confront coders as they prepare to implement the new rule that becomes effective Oct. 1, 2025.As a sidebar, Dr. Kennedy, along with nationally recognized coding authority Christine Geiger, will team up for the 2026 IPPS Masterclass series, taking place live Aug. 13, 14, and 15.The popular weekly Internet broadcast will also feature these additional instantly recognizable panelists, who will report more news during their segments:• CDI Report: Cheryl Ericson, Director of clinical documentation integrity (CDI) for the vaunted Brundage Group, will have the latest CDI updates.• The Coding Report: Christine Geiger, Assistant Vice President of Acute and Post-Acute Coding Services for First Class Solutions, will report on the latest coding news.• News Desk: Timothy Powell, ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.• MyTalk: Angela Comfort, veteran healthcare subject-matter expert, will co-host the long-running and popular weekly Internet broadcast. Comfort is the Assistant Vice President of Revenue Integrity for Montefiore Health.

On this accredited episode of NP Pulse: The Voice of the Nurse Practitioner®️, join representatives from the Centers for Medicare & Medicaid Services (CMS) as they provide an overview of the Open Payments program — a national initiative that promotes transparency in health care by tracking payments from drug and medical device companies to certain health care providers. Since Jan. 1, 2021, nurse practitioners have been included as covered recipients. In this session, you'll learn how the program works, explore key data insights and understand your role and responsibilities. A participation code will be provided at the END of the podcast — make sure to write this code down. Once you have listened to the podcast and have the participation code, return to this activity in the AANP CE Center. Click on the "Next Steps" button of the activity and Enter the participation code that was provided Complete the post-test Complete the activity evaluation This will award your CE credit and certificate of completion. 1.0 CE will be available through Aug. 31, 2026.

A new federal law is reshaping how healthcare is paid for and delivered in America.In this episode, Steve sits down with health policy expert Joe Mercer to unpack the details of the One Big Beautiful Bill Act. It's the most significant healthcare legislation since the ACA, with ripple effects across Medicaid, rural hospitals, and the ACA exchange.We cover:

Attention, calling all coders!Is your hospital compliantly following all the the steps in the Condition Code W2 process?It's imperative to understand all the details that must be followed, no matter how complex and daunting.Implementation is mandated by the Centers for Medicare & Medicaid Services (CMS). Participation is not optional. So take a moment and ask yourself: are your attending physicians re-billing for Medicare Part B patients?During the next live edition of the popular live Internet broadcast Talk Ten Tuesdays, the Medical Director of Phoenix Medical Management, Inc., Dr. Juliet Ugarte Hopkins, will walk you and your team through the requirements that need to be followed for Medicare Part B re-billing.The popular Internet broadcast will also feature these additional instantly recognizable panelists, who will report more news during their segments:• Social Determinants of Health: Tiffany Ferguson, CEO for Phoenix Medical Management, Inc., will report on the news that is happening at the intersection of medical record auditing and the SDoH;• The Coding Report: Christine Geiger, Assistant Vice President of Acute and Post-Acute Coding Services for First Class Solutions, will report on the latest coding news;• News Desk: Timothy Powell, ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk; and• MyTalk: Angela Comfort, veteran healthcare subject-matter expert, will co-host the long-running and popular weekly Internet broadcast. Comfort is the Assistant Vice President of Revenue Integrity for Montefiore Health.

Sudo patch your Linux systems. Cisco has removed a critical backdoor account that gave remote attackers root privileges. The Hunters International ransomware group rebrands and closes up shop. The Centers for Medicare and Medicaid Services (CMS) notifies 103,000 people that their personal data was compromised. NimDoor is a sophisticated North Korean cyber campaign targeting macOS. Researchers uncover a massive phishing campaign using thousands of fake retail websites. The FBI's top cyber official says Salt Typhoon is largely contained. Microsoft tells customers to ignore Windows Firewall error warnings. A California jury orders Google to pay $314 million for collecting Android user data without consent. Ben Yelin shares insights from this year's Supreme Court session. Ransomware negotiations with a side of side hustle. Remember to leave us a 5-star rating and review in your favorite podcast app. Miss an episode? Sign-up for our daily intelligence roundup, Daily Briefing, and you'll never miss a beat. And be sure to follow CyberWire Daily on LinkedIn. CyberWire Guest Today our guest is Ben Yelin from UMD CHHS, who is sharing a wrap up of this year's Supreme Court session. If you want to hear more from Ben, head on over to the Caveat podcast, where he is co-host with Dave as they discuss all things law and privacy.  Selected Reading Linux Users Urged to Patch Critical Sudo CVE (Infosecurity Magazine) Cisco warns that Unified CM has hardcoded root SSH credentials (Bleeping Computer) Hunters International ransomware shuts down after World Leaks rebrand (Bleeping Computer) Feds Notify 103,000 Medicare Beneficiaries of Scam, Breach (Data Breach Today) N Korean Hackers Drop NimDoor macOS Malware Via Fake Zoom Updates (Hackread) China-linked hackers spoof big-name brand websites to steal shoppers' payment info (The Record) Top FBI cyber official: Salt Typhoon ‘largely contained' in telecom networks (CyberScoop) Microsoft asks users to ignore Windows Firewall config errors (Bleeping Computer) California jury orders Google to pay $314 million over data transfers from Android phones (The Record) US Probes Whether Negotiator Took Slice of Hacker Payments (Bloomberg) Audience Survey Complete our annual audience survey before August 31. Want to hear your company in the show? You too can reach the most influential leaders and operators in the industry. Here's our media kit. Contact us at cyberwire@n2k.com to request more info. The CyberWire is a production of N2K Networks, your source for strategic workforce intelligence. © N2K Networks, Inc. Learn more about your ad choices. Visit megaphone.fm/adchoices

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers is joined by Michael Chernew from Harvard Medical School to discuss the recently released National Health Expenditures Projections for 2024–33 from the Office of the Actuary (OACT) at the Centers for Medicare and Medicaid Services (CMS).Related Articles:National Health Expenditure Projections, 2024–33: Despite Insurance Coverage Declines, Health To Grow As Share Of GDPCMS National Health Expenditure Data Subscribe to UnitedHealthcare's Community & State newsletter.

Dr. Amelia Bond and Dr. Dhruv Khullar join us to discuss the long-term savings of accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP). Their recent study in JAMA found that ACOs generate increasing savings over time, with physician-led ACOs demonstrating more significant savings. Learn about their study's methodology, policy implications for The Centers of Medicare & Medicaid Services (CMS) and where Dr. Bond and Dr. Khullar will focus their research next. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

Join Col. Dr. Damon Arnold, host of America's Heroes Group, as he speaks with Julie Appleby, Senior Correspondent for KFF Health News. In this episode, they explore the implications of Julie's recent article, "The Ranks of Obamacare 'Fixers' Axed in Trump's Reduction of Health Agency Workforce," published on April 22, 2025. Discover how critical caseworker positions at the Centers for Medicare and Medicaid Services (CMS) are being cut, the consequences for ACA enrollees, and the broader impact on public health systems across the United States.Topics:Introduction to Julie Appleby and Her Work with KFF Health NewsOverview of the Affordable Care Act (ACA) Caseworker ProgramThe Role of Caseworkers: Who Are the "Fixers" and What Do They Do?The Trump Administration's Reduction in Health Agency WorkforceThe Fallout: How ACA Enrollees Are Affected by Caseworker LayoffsImpact on the CMS Exchange Customer Solutions GroupImplications for ACA Navigators and the Reduction in Support ServicesBroader Public Health Concerns: Medicaid, Mental Health, and Chronic DiseasesThe Future of Healthcare Access in the U.S.: What to Expect in 2025 and BeyondQ&A and Final Remarks

Dr. Jordan B. Peterson sits down for a candid discussion with Dr. Mehmet Oz, discussing the toxified food environment within the United States—pointing directly to its causes—and exploring not just possible, but immediate routes for change. These include better governmental oversight, but also the implementation of new technologies such as AI. Dr. Mehmet Oz, newly appointed by President Donald Trump as the 17th Administrator of the Centers for Medicare and Medicaid Services (CMS), is a cardiothoracic surgeon, professor emeritus at Columbia University, and former leader of the heart institute at New York Presbyterian Medical Center, known for innovations like the Mitraclip and over 400 publications in heart surgery, health policy, and complementary medicine. He gained national fame through The Dr. Oz Show, winning nine Daytime Emmys and authoring several New York Times bestsellers, before becoming the 2022 Republican nominee for U.S. Senate in Pennsylvania. A Harvard and UPenn MD/MBA graduate, Oz also co-founded the influential health platform Sharecare and the nationwide teen wellness initiative Healthcorps. His public influence has been recognized by Time, Forbes, and Esquire, making him a high-profile figure at the intersection of medicine, media, and policy. This episode was filmed on November 13th, 2024  | Links | For Dr. Mehmet Oz: On X https://x.com/droz?lang=en On Instagram https://www.instagram.com/dr_oz/?hl=en Dr. Mehmet Oz shares his vision for CMS https://www.cms.gov/newsroom/press-releases/dr-mehmet-oz-shares-vision-cms   

Alex Lawson - A call for protecting the integrity of Social Security, Medicare, and Medicaid following reports that DOGE has accessed the Centers for Medicare and Medicaid Services (CMS) and intends to access SSA next. Trump to IRS: stop investigating Rich tax cheats and instead go catch some brown people who are here without authorization.Is anyone surprised PBS caves to Trump and closes their DEI program - I have my doubts this will help them. Morgan J Freeman: "Anthem Blue Shield Blue Cross -- just denied cancer follow-up MRI to check spread was deemed "not a medical necessity" and therefore “not authorized." See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.