Government Archives - HIT Leaders and News

No Surprises Act IDR Rule Targets Out of Network Dispute Backlog

Jason Free — Mon, 01 Jun 2026 10:00:08 +0000

The federal government’s latest changes to the No Surprises Act are not about reopening the patient protection debate. That debate has largely settled. Patients should not be placed in the middle of surprise out-of-network billing disputes when they had little control over where or by whom care was delivered.

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HHS AI Fraud Detection Raises Stakes for Medicare and Medicaid Oversight

Jason Free — Wed, 27 May 2026 10:05:47 +0000

The U.S. Department of Health and Human Services is moving artificial intelligence deeper into healthcare fraud oversight, and the implications extend beyond enforcement headlines. The shift reflects a broader federal attempt to move program integrity from retrospective investigation toward earlier detection, faster intervention, and stronger accountability for entities receiving federal healthcare dollars.

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Prior Authorization Enters Its Test Phase

Jason Free — Mon, 18 May 2026 10:44:44 +0000

The next phase of prior authorization reform will not be decided by whether healthcare organizations support electronic exchange in principle. That consensus already exists. The real test is whether payers, providers, EHR developers, networks, and digital health companies can make electronic prior authorization work inside the messy conditions of actual care delivery.

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CMS Solidifies Rural Health Transformation Office, but Execution Risks Remain

Jason Free — Thu, 30 Apr 2026 20:16:36 +0000

The Centers for Medicare & Medicaid Services has formally established the Office of Rural Health Transformation (ORHT), a move that converts legislative momentum into structural commitment. As the operational steward of the $50 billion Rural Health Transformation (RHT) Program, launched under the Working Families Tax Cut legislation, the ORHT is now tasked with overseeing one of the most ambitious rural health efforts in U.S. history.

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CMS and FDA RAPID: Faster Device Coverage Needs Stronger Evidence Discipline

Jason Free — Tue, 28 Apr 2026 11:41:01 +0000

The new RAPID coverage pathway from the Centers for Medicare and Medicaid Services and the U.S. Food and Drug Administration reflects a long-running frustration in medical technology policy: authorization and coverage are separate decisions, and patients often wait in the gap between the two.

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Doctor Arrested, Accused of Health Care Fraud, Illegally Prescribing Drugs: Fraud Risk Starts With Weak Supervision

Jason Free — Mon, 27 Apr 2026 18:38:33 +0000

The federal indictment of a Columbia, Missouri urgent care physician should not be read only as an allegation of individual misconduct. It also is a warning about what can happen when clinical delegation, billing authority, and controlled substance prescribing operate without durable oversight.

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CMS Medicaid Payment Rule Targets State Directed Payments

Jason Free — Sun, 26 Apr 2026 10:43:30 +0000

The Centers for Medicare & Medicaid Services proposal to cap certain Medicaid payment arrangements is a direct challenge to the financing structures states and providers have increasingly used to support Medicaid reimbursement, especially in managed care.

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HHS Announces $4 Million KidneyX EMPOWER Prize Challenge and Health Technology Project

Jason Free — Mon, 20 Apr 2026 11:49:31 +0000

The new living-donor prize challenge from the Department of Health and Human Services is a useful signal, but the signal matters more than the purse. The federal government is implicitly acknowledging that living kidney donation has not been held back by a lack of goodwill or a lack of clinical capability.

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Brace Fraud Exposes Medicare’s Order Blind Spot

Jason Free — Mon, 20 Apr 2026 11:39:51 +0000

The April 14 sentencing of a Florida nursing assistant in an $11.4 million orthotic-brace fraud scheme is easy to treat as a familiar enforcement item. According to the Department of Justice, the defendant used a Florida durable medical equipment supplier to bill Medicare for braces that beneficiaries did not request or need, while concealing true ownership and relying on illegal kickbacks to obtain signed doctors’ orders, as outlined in the April 14 sentencing announcement.

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Prior Authorization Enters Its Infrastructure Era

Jason Free — Tue, 14 Apr 2026 12:32:07 +0000

The Centers for Medicare & Medicaid Services is using its 2026 proposed rule on interoperability and drug prior authorization to do more than shorten approval timelines.

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