Government Archives - Page 13 of 64

Government

The CMS Rule That Finally Targets the Paperwork Nobody Fixed

The latest move from the Centers for Medicare & Medicaid Services will be easy to underestimate because it sounds so administrative. The newly finalized health care claims attachments rule deals with documentation, transaction standards, and electronic signatures, not a flashy care model or a breakthrough therapy. Yet it may prove to be one of the more important healthcare modernization actions in years precisely because it aims at a part of the system that has remained stubbornly primitive long after the industry declared itself digital.

March 23, 2026

Photo 260384678 © Timon Schneider | Dreamstime.com

When Fraud Reaches the Exam Room

The federal case against Anchorage rheumatologist Claribel Tan should not be read as a routine fraud prosecution with unusually vivid facts. In a March 17 sentencing release from the U.S. Attorney’s Office for the District of Alaska, the Department of Justice said the scheme involved more than $12.5 million in health care fraud, more than $4.2 million in tax loss, and conduct that stretched across 15 years. What makes the case editorially important is not only the money. It is the allegation that the fraud was built into treatment itself.

March 23, 2026

Photo 33983800 © Feverpitched | Dreamstime.com

CMS Rule Phases Out Fax Machines and Snail Mail

The latest administrative simplification rule from the Centers for Medicare & Medicaid Services may sound like a narrow technical update, but in its final rule fact sheet the agency says it creates the first HIPAA-adopted standards for health care claims attachments and electronic signatures. That makes the policy less about retiring fax machines than about fixing one of healthcare’s oldest operational failures: the messy, manual handoff between clinical documentation and payment.

March 22, 2026

Photo 260384658 © Timon Schneider | Dreamstime.com

Caregiver AI Must Earn Its Place in the Home

The launch of the Caregiver AI Prize Competition by the Administration for Community Living under the U.S. Department of Health and Human Services signals a policy shift that matters beyond a single challenge. Federal leaders are no longer treating caregiving technology as a consumer convenience category. The competition frames AI as a potential layer of national caregiving infrastructure, with explicit expectations around responsible use and harm prevention. That framing raises the bar for what counts as a viable solution in the home.

HHS Adds Former U.S. Attorney for Fraud Efforts

The appointment of former U.S. Attorney Scott Brady to the U.S. Department of Health and Human Services (HHS) Office of General Counsel signals a sharp escalation in the agency’s fraud enforcement strategy. Joining General Counsel Mike Stuart, himself a former federal prosecutor, Brady enters HHS amid what leadership calls the most aggressive anti-fraud campaign in the agency’s history. The move reflects a strategic posture shift: from administrative oversight to criminal accountability.

United States Completes WHO Withdrawal

The finalization of the United States’ withdrawal from the World Health Organization (WHO) marks a seismic shift in global health governance, one that exposes critical uncertainties for healthcare leaders, public health systems, and the infrastructure supporting pandemic readiness. While federal leadership characterized the move as a necessary correction to institutional failure, the long-term implications for operational coordination, global surveillance, and regulatory alignment remain unresolved.

Trump’s Healthcare Plan Forces a New Reckoning on Price Transparency

The healthcare policy landscape in the United States has again shifted with the unveiling of former President Donald Trump’s proposed Great Healthcare Plan. While the political context surrounding the proposal may spark predictable partisan reactions, the plan itself raises a deeper, more systemic challenge: how far can, and should, price transparency, consumer-directed benefits, and direct subsidies go in reshaping how healthcare is purchased, priced, and governed?

Kaiser Permanente Settlement Highlights Breakdown in Medicare Advantage Risk Practices

The recent $556 million settlement by Kaiser Permanente affiliates over inflated Medicare Advantage payments underscores a persistent and unaddressed compliance risk embedded within the risk adjustment ecosystem. The allegations point to systemic pressure on physicians to append diagnoses not considered during patient encounters, practices that, if validated, reveal how financial incentives tied to coding can distort clinical records and degrade payer trust.

DEA & HHS Extend Telemedicine Flexibilities for Prescribing Controlled Medications Through 2026

The fourth federal extension of telemedicine prescribing flexibilities for controlled substances offers temporary relief, but not long-term certainty, for healthcare systems navigating hybrid care delivery. The joint decision by the Department of Health and Human Services and the Drug Enforcement Administration to prolong pandemic-era telemedicine allowances through the end of 2026 is framed as a move to protect patients.

Price Transparency Won’t Fix Health Care Until the Data Does

The latest proposed updates to federal price transparency regulations signal a deeper acknowledgment of an uncomfortable truth: health care pricing data is now technically public, but still functionally unusable. The Centers for Medicare & Medicaid Services (CMS), working with the Departments of Labor and Treasury, aims to correct this mismatch by simplifying data formats, reducing redundancies, and making cost tools more accessible. But unless these changes are paired with a broader shift in how price transparency is operationalized across the system, their impact may remain symbolic rather than structural.

AI Ambitions Meet Systemic Barriers in HHS Push for Clinical Adoption

The U.S. Department of Health and Human Services (HHS) has issued a sweeping Request for Information (RFI) to identify how artificial intelligence (AI) can accelerate clinical transformation across the American healthcare system. Framed as a call to harness AI for lower costs and improved care, the initiative invites input on everything from evolving reimbursement frameworks to rethinking regulatory pathways. But beneath the enthusiasm lies a complex set of operational, legal, and ethical dynamics that will shape whether these ambitions translate into scalable realities.

Botox Fraud Case Underscores Persistent Gaps in Medicare Oversight

A newly unsealed federal indictment against a Los Angeles-area physician alleges a $45 million Medicare fraud scheme involving falsified Botox claims, exposing once again the operational vulnerabilities that continue to undermine the integrity of federal health programs. The charges against Dr. Violetta Mailyan include wire fraud and obstruction of justice, centered on billing for procedures that were medically unnecessary or never performed. While the case is still pending, it signals ongoing systemic exposure to high-value, low-detection fraud.

CMS Bets on Mandatory Drug Model to Break Medicare Part D Pricing Gridlock

The Centers for Medicare & Medicaid Services (CMS) has proposed a new mandatory payment model aimed at lowering prescription drug costs for Medicare beneficiaries, a move that underscores both the urgency and complexity of reforming drug pricing in the United States. Dubbed the Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model, the initiative introduces international price benchmarking and modified rebate structures to rein in spending under Medicare Part D. But while the model reflects an aggressive policy posture, it also raises significant implementation and equity questions as it moves toward a 2027 launch.

Device Fraud and Diagnostic Failure Underscore Urgent Gaps in Health IT Accountability

The criminal convictions of three former executives at Magellan Diagnostics mark more than the end of a federal case. They spotlight a fundamental breakdown in how health IT tools are regulated, trusted, and used to guide clinical decisions. From 2013 to 2017, Magellan’s LeadCare II device accounted for the majority of pediatric lead screenings in the United States.

HHS AI Strategy Sets a Federal Precedent, But Stops Short of Sector-Wide Reform

The U.S. Department of Health and Human Services (HHS) has released its first unified artificial intelligence (AI) strategy, positioning AI as a transformative tool for internal operations, public health research, and care modernization. Framed as a “OneHHS” approach, the strategy invites coordination across all departmental divisions, including CDC, CMS, FDA, and NIH.