The Minnesota Department of Human Services is adding more than 160 staff members to review nearly 6,000 Medicaid providers for potential fraud as part of a broader effort to address federal concerns. The review will target 13 high-risk Medicaid programs and involve paperwork reviews and unannounced site visits.

Tracy Hofius, former executive director of the North Star Child Development Center in Coeur d'Alene, Idaho, has been sentenced to three years of probation for public assistance provider fraud. Hofius was ordered to pay $154,119 in restitution after admitting to submitting incorrect billing information to the Idaho Department of Health and Welfare, resulting in $150,000-plus in losses to Medicaid.

Dr. John Stevenson Bynon Jr., former director of abdominal organ transplantation at Memorial Hermann Health System, has been indicted on charges of making false statements in health care matters. Prosecutors allege Bynon falsified records to make patients ineligible for organ transplants, without their knowledge or the knowledge of their care team. Bynon faces five years in prison and a $250,000 maximum fine if convicted.

Oracle Health has added functionality to its Clinical AI Agent to automatically draft orders during patient appointments using ambient listening and semantic reasoning. The system analyzes patient history and physician preferences to draft clinical orders for prescriptions and diagnostic tests.

Medicare Advantage faces challenges from recent policy changes that have led to a decrease in plan choices, reduced supplemental benefits and greater out-of-pocket costs for beneficiaries, write Donna Shalala and Tommy Thompson, both former HHS secretaries. Shalala and Thompson, who played key roles in the program's development, note that the policy changes stem from a narrative that MA has failed to reduce Medicare spending, although enrollment is strong and satisfaction is high.

In 2021, more than a quarter of physicians enrolled in Medicaid did not treat any Medicaid patients, according to a study published in Health Affairs. The research found psychiatrists were most likely to be "ghost providers," while cardiologists and primary care physicians were least likely. Researchers suggest policymakers improve Medicaid participation, especially in mental and behavioral health, by increasing reimbursement rates or creating other incentives for clinicians.

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