US health spending spikes to $5.7T in 2025, though growth should moderate, CMS finds
Rebecca Pifer Parduhn / healthcaredive - Utilization — not cost growth — continues to accelerate spending, government actuaries said. Spiking prescription drug spending, including on GLP-1s, is especially acute.
AI Summary: A new CMS analysis shows U.S. health spending will jump sharply — hitting roughly $5.7 trillion in 2025 — with long‑term projections approaching $9 trillion by 2034. The report attributes growth to demographics, price and service use, while cautioning that growth rates should moderate. Policymakers face the delightful task of paying for care nobody asked to be cheaper.
DOJ announces $6.5B healthcare fraud takedown with record Medicaid enforcement
fiercehealthcare - Law enforcement unveiled charges against 455 defendants for their alleged participation in healthcare schemes, among which fraudulent amniotic wound allografts and undelivered Medicaid services were spotlighted.
AI Summary: The Department of Justice announced a sweeping $6.5 billion healthcare fraud enforcement action, charging multiple defendants in schemes involving fraudulent billing, shell companies and luxury purchases. The coordinated takedown underscores ongoing federal efforts to police Medicare and Medicaid fraud and recover misspent taxpayer funds.
- Corporate Civil Suits and Settlements in Healthcare Fraud (3)
- Mass DOJ Takedown: 455 Charged in $6.5B Fraud (5)
Corporate Civil Suits and Settlements in Healthcare Fraud
Mass DOJ Takedown: 455 Charged in $6.5B Fraud
Final rules for Medicaid work requirements are out
medicalxpress - The Trump administration has issued final rules on how states should ensure that millions of Medicaid enrollees prove they're working or completing other activities, such as job training, volunteering or being enrolled in an educational program.
AI Summary: The administration finalized new Medicaid work requirement rules, prompting insurers and states to adjust operations, eligibility verification and outreach plans. Industry actors are mobilizing systems and program supports to reduce coverage disruptions while preparing for shifts in enrollment and administrative burden — because nothing says "efficiency" like last-minute policy whiplash.
Centene offers employee buyouts amid membership losses
Rebecca Pifer Parduhn / healthcaredive - Most of Centene’s 61,000 employees will be eligible to apply for voluntary separation. But the program doesn’t amount to a complete overhaul of the company, a spokesperson said.
AI Summary: Centene has initiated a large voluntary buyout program as slipping membership and financial pressure force quick capacity reduction. The insurer is offering exit packages to many employees to reduce costs and reposition operations while it navigates enrollment headwinds and regulatory uncertainty — a tidy little corporate haircut with major workforce consequences.
CMS creates Office of Health Technology and Products
Naomi Diaz / beckershospitalreview - The Centers for Medicare & Medicaid Services has established a new Office of Health Technology and Products to oversee healthcare technology modernization, digital products and platform transformation across the agency’s programs. The organizational chang…
AI Summary: CMS has created a dedicated Office of Health Technology and Products to centralize oversight of digital health tools, including AI and emerging medical technologies. The new office will coordinate evaluation, guidance and implementation policies across CMS programs to speed safe adoption, improve interoperability and provide clearer regulatory expectations for health systems and vendors.
Medically tailored meals produce better health and lower costs, analysis finds
medicalxpress - At least a dozen U.S. states are rolling out medically tailored meals in pilot projects through Medicaid, the federal-state health insurance program serving 71 million Americans who qualify based on income or disability status.
AI Summary: Analyses of medically tailored meal programs, including a Massachusetts Medicaid demonstration, show reduced hospital use and lower healthcare costs alongside measurable health benefits. The findings bolster calls to move 'food is medicine' from pilot projects into mainstream policy — because apparently feeding patients the right food is cheaper than fixing the mess afterward.
CMS releases Medicaid work requirements guidance for states
Rebecca Pifer Parduhn / healthcaredive - The highly anticipated interim final rule weighs in on key issues for states hustling to operationalize work requirements before the 2027 deadline. But there’s still some gray area — and lots of critics.
AI Summary: The Centers for Medicare & Medicaid Services released a national framework for implementing Medicaid work requirements, giving states guidance on eligibility, reporting and enforcement. The directive outlines guardrails and operational expectations while leaving significant discretion to states, prompting debate over access, administrative burden and potential gaps in coverage during rollout.
Massachusetts sues UnitedHealthcare over alleged $100M in fraudulent Medicaid payments
Elizabeth Casolo / beckershospitalreview - Massachusetts filed a lawsuit against UnitedHealthcare, accusing the insurer of retaining more than $100 million in fraudulent Medicaid payments. The May 29 complaint, filed in a state court, focuses on UnitedHealthcare’s role as a contractor for “Senior …
AI Summary: The Massachusetts attorney general filed a civil suit accusing UnitedHealthcare of submitting improper Medicaid payments, alleging roughly $100 million in fraudulent claims tied to managed‑care contracts. The action seeks recovery and oversight remedies as state regulators press insurers on billing practices, underscoring growing scrutiny of Medicaid managed‑care arrangements.
CMS Finalizes Rule to Simplify Payer-Provider Disputes Under No Surprises Act
Katie Adams / medcitynews - CMS finalized a new rule aimed at streamlining the No Surprises Act’s overwhelmed arbitration system. Provider groups largely welcomed the reforms — though some industry leaders said additional changes are still needed to address alleged misuse and improv…
AI Summary: The Centers for Medicare & Medicaid Services finalized a rule to simplify payer‑provider disputes under the No Surprises Act, updating the dispute resolution process and implementing a payer registry and portal changes. The aim is to reduce administrative friction, speed dispute handling, and make billing arbitration less of an endurance sport for providers and insurers.
- Final rule: new portal and payer registry details (3)
- Insurers push back; provider legal fights over payments (3)
- Patient fallout: medical debt and surprise billing stories (3)
Final rule: new portal and payer registry details
Insurers push back; provider legal fights over payments
Patient fallout: medical debt and surprise billing stories
CMS launches initiative to speed electronic prior authorization adoption
Emily Olsen / healthcaredive - The effort, part of the agency’s ambitious Health Tech Ecosystem, aims to accelerate the industry’s progress before requirements on electronic prior authorization go into effect next year.
AI Summary: CMS launched a national initiative to accelerate adoption of electronic prior authorization, recruiting major health‑IT vendors and health systems to pilot interoperable digital workflows. The program aims to cut paperwork and speed care decisions by automating approvals, though providers warn integration challenges and real‑world impact will take time to materialize.
- AI and automation firms reshaping prior authorization workflows (4)
- CMS' national push to accelerate electronic prior authorization (3)
- Policy fights, insurer delays and patient impact of prior auth (4)
- All Other Stories
AI and automation firms reshaping prior authorization workflows
CMS' national push to accelerate electronic prior authorization
Policy fights, insurer delays and patient impact of prior auth
All Other Stories
Centene raises 2026 guidance with strong Q1 revenue, earnings results
fiercehealthcare - Centene kicked off the first quarter with better-than-expected revenue and adjusted earnings results, signaling a recovery from a rough 2025 as the insurer makes progress in managing medical costs.
AI Summary: Centene lifted its 2026 outlook after reporting robust first-quarter revenue and results, signaling confidence in managed care performance and enrollment trends. The company cited favorable operational metrics and market dynamics that supported the guidance bump, reassuring investors even as broader industry headwinds remain in play.
CMS to require states to audit Medicaid providers
Kristin Kuchno / beckershospitalreview - CMS Administrator Mehmet Oz, MD, said his administration will require all states to audit healthcare providers to address alleged Medicaid fraud, Politico reported April 21. Dr. Oz unveiled the plan at Politico’s Health Care Summit. Beginning this week, C…
AI Summary: CMS is requiring states to audit Medicaid providers as part of a new oversight initiative aimed at tightening program integrity and provider revalidation. The policy has sparked high‑level calls for nationwide reviews and a proposed 50‑state audit effort, signaling heightened federal scrutiny and potential changes to enrollment, billing and provider eligibility processes.
Baylor Scott & White Health Plan to exit Medicaid, individual markets; cut 321 jobs
Jakob Emerson / beckershospitalreview - Baylor Scott & White Health Plan said April 14 it will exit the Texas Medicaid managed care market and discontinue its individual marketplace plans, affecting roughly 225,000 members and eliminating 321 jobs statewide, according to the Dallas Morning News…
AI Summary: Baylor Scott & White announced it will leave Medicaid individual markets, a move that will shed hundreds of jobs and reshape coverage options for affected enrollees. The decision highlights ongoing financial pressures in public‑program participation and raises practical concerns about access continuity for people reliant on those plans.