Prosecutors in New York say a New Windsor couple submitted nearly $2.9 million worth of fraudulent Medicaid claims for transportation services over a four-year span. Prosecutors said Rohail Raja and Sharma Alam billed for trips that did not occur and claimed that patients were transported separately when they were not. The defendants were arrested and jailed.

Ryan Carroll, owner of a now-defunct LLC named The Knights of Ni, faces seven felony charges for allegedly defrauding Alaska's Medicaid system of more than $500,000 between 2018 and 2022. Investigators with the Alaska Medicaid Fraud Control Unit say Carroll, who worked as a care coordinator, missed reports that could have caused clients to lose their health insurance, documented contacts with more than one client simultaneously but at different places, and failed to submit the proper forms for billing Medicaid. The company was dissolved in 2024.

AI has yielded a return on investment in claim denial prevention and appeals by identifying gaps in documentation and reducing the cost of appeals. AI has changed how Beth Israel Lahey Health has approached coding and documentation, says Vice President of Mid-Revenue Cycle Keisha Downes. Moffitt Cancer Center has collected $500,000 that would otherwise have been written off since adopting AI to appeal low-dollar claims, says Director of Business Operational Transformation Bill Arneson. Downes and Arneson both say that organizations adopting AI should start small, focus on culture and upskill staff.

Conduent Business Solutions, a back-end processing and payment services company, reported a data breach affecting millions of people across several states, including more than 4 million in Texas and over 1 million in Oregon. The breach occurred from October 2024 to January 2025, and involved the exfiltration of personal information. Blue Cross and Blue Shield of Montana and Premera Blue Cross in Washington are among the insurers that have posted notices related to the breach.

Medicare Part D spending on disease-modifying therapies for immune-mediated neurologic disorders, such as multiple sclerosis, increased by 70% from 2013 to 2022, but usage remained stable at 2% of claims, according to a study in JAMA Network Open. Claims for 29 DMTs decreased by 15% over the study period, but total payments for those drugs increased by 33% after adjusting for prescription drug inflation. Overall, DMTs accounted for 41% of Medicare drug expenditures.

For-profit hospital systems' third-quarter earnings exceeded analysts' expectations due in part to payments from state Medicaid supplemental payment programs. Community Health Systems, HCA Healthcare and Universal Health Services all reported significant revenue increases attributed to these payments. Although some of the payments were one-time items, they contributed to updated financial projections for the year.