A shift in Medicaid financing policy is underway. The Centers for Medicare & Medicaid Services (CMS) has released preliminary guidance on new federal limits for State Directed Payments (SDPs), a move tied to the implementation of the One Big Beautiful Bill Act. Although the rule is not yet final, CMS is offering early instructions to help states prepare for significant restrictions on how managed care dollars can be directed.

The U.S. Department of Health and Human Services (HHS) has initiated internal access to OpenAI’s ChatGPT for employees across its agencies, signaling one of the largest coordinated efforts by a federal health entity to institutionalize generative artificial intelligence. In an email reportedly distributed department-wide, HHS Deputy Secretary Jim O’Neill encouraged broad use of the tool while also issuing cautionary notes around security and regulatory compliance.

A new federal complaint against a Middletown, Connecticut resident reveals just how quickly durable medical equipment (DME) fraud can metastasize in Medicare Advantage. Between February and June of this year, a company with no physical patients, no in-state activity, and a business address at a shared office space submitted over $680,000 in claims for orthotics never provided to any beneficiary.

The case of Armen Muradyan, owner of Genex Laboratories, is a structural warning. With more than $11 million in unpaid taxes, fraudulent Medicare reimbursements, and misuse of COVID-19 relief funds, the case reveals how regulatory loopholes in lab ownership, Medicare enrollment, and financial reporting can be manipulated to sustain years of illegal activity with limited institutional detection.

For decades, price transparency at the point of care has been a policy aspiration more than an operational reality. But new regulatory changes finalized by the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) mark a shift from aspiration to enforceable expectation.

The recent sentencing of Paul Njoku, former CEO of Opnet Health Care Services (operating as P & P Health Care Services), to more than six years in federal prison for orchestrating a multi-year Medicare fraud scheme, is less a story of exceptional criminality than it is a reflection of chronic system-level vulnerability. The mechanisms exploited, fabricated documentation, fraudulent credentialing, and the submission of falsified claims, are not outliers. They are foreseeable consequences of policy architecture that remains persistently ill-equipped to verify eligibility, documentation, or intent at the point of submission.

The Centers for Medicare & Medicaid Services (CMS) has unveiled the “Crushing Fraud Chili Cook-Off Competition,” a market-driven research initiative designed to leverage explainable artificial intelligence (AI) to identify fraud indicators and propose scalable solutions within the Medicare Fee-for-Service (FFS) program. The challenge invites innovative proposals that integrate machine learning (ML) with transparency and accountability, aiming to modernize fraud detection while preserving human oversight.

In a sweeping realignment of federal regulatory oversight, the U.S. Department of Health and Human Services (HHS) has transferred enforcement authority for 42 CFR Part 2, the regulation protecting the confidentiality of substance use disorder (SUD) treatment records, to the Office for Civil Rights (OCR), the same office responsible for HIPAA compliance. While the move aims to harmonize privacy frameworks and streamline complaint resolution, it places a significantly increased burden on an already under-resourced agency.