Cencora's ASD Specialty Healthcare has agreed to a $1.67 million settlement to resolve allegations that it provided free inventory management systems to retina practices to encourage drug purchases in violation of anti-kickback laws. Prosecutors say that the kickback arrangements led to physicians submitting false claims to Medicare, the Department of Veterans Affairs and Tricare.

Christopher Mazzei and Erin Mazzei of Arroyo Grande, Calif., have been sentenced to 36 months and 27 months in prison, respectively, for defrauding the Paycheck Protection Program. The couple used false IRS and payroll information in applications submitted to banks, receiving $1.37 million in funds, which they used for personal expenses, including purchasing vehicles and a home.

Fredrick Mendez of Boca Raton, Fla., has received a 41-month prison sentence and has been ordered to pay $1.59 million in restitution after entering a guilty plea to wire fraud. Mendez submitted fraudulent Paycheck Protection Program and Economic Injury Disaster Loan applications, which included false information about employee numbers and revenue, for several businesses, using the funds for personal gain, officials say.

AI systems in health care, such as those predicting patient outcomes, require significant human oversight and maintenance to remain effective, as seen at the University of Pennsylvania Health System, where an algorithm's performance declined during the pandemic. "Everybody thinks that AI will help us with our access and capacity and improve care and so on," says Nigam Shah, chief data scientist at Stanford Health Care. "All of that is nice and good, but if it increases the cost of care by 20%, is that viable?"

The CMS has proposed a 2.23% increase in Medicare Advantage benchmark payments for 2026, translating to a $21 billion rise in payments to MA plans. This proposal contrasts with a 0.16% decrease last year and continues the implementation of the MA risk adjustment model.

State lawmakers are preparing for potential Medicaid cuts as President-elect Donald Trump and Congress consider reducing funding to offset tax cuts. Nine states have laws that would end expansion of the program if federal funding falls below 90%, while laws in three states would allow legislators to end expansion, raising concerns among policymakers and health care providers about the impact on vulnerable populations and state budgets.

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