Janice Cliver-Dudash, a licensed professional counselor from Ocoee, Tenn., was convicted of Medicaid fraud, identity theft and violating the Oklahoma Computer Crimes Act and received a seven-year deferred sentence. Authorities said that Cliver-Dudash submitted fraudulent claims, including those for people who were deceased. Separately, Maria Dianda, a board-certified behavioral analyst, pleaded guilty to Medicaid fraud and identity theft for submitting claims for services not provided and received a three-year deferred sentence.

Misty Dawn Woody, a former employee of Vital Care EMS in Anderson County, S.C., has been indicted and accused of falsifying medical documents, resulting in $1.8 million in Medicare billings and about $936,000 in payments to Vital Care. Woody allegedly kept presigned Physician Certification Statement forms and forged a doctor's signature on about 100 forms to facilitate the scheme.

Illinois chiropractor Sean Rondeau was sentenced to a year and a day in federal prison for defrauding health insurance companies of more than $250,000. Rondeau, who a judge noted was previously caught committing fraud more than a decade ago, submitted over 2,000 fraudulent claims and attempted to cover up his actions when he learned of the investigation.

The American Medical Association's CPT Editorial Panel has updated the AI taxonomy in Appendix S to the Current Procedural Terminology code set for the classification and reporting of AI use in clinical care. The changes clarify distinctions between assistive, augmentative and autonomous AI technologies; and define certain terms, such as "derived parameters" and "clinically meaningful."

The CMS has reassured stakeholders that there are no plans to eliminate Medicare brokers or limit their role in assisting beneficiaries. This clarification follows CMS Administrator Mehmet Oz's suggestion to use AI to help beneficiaries navigate Medicare options. The agency also clarified that it is not pursuing any policy to discontinue Medigap plans or reduce broker involvement.

Nearly half of payers remain unwilling to cover GLP-1 medications for obesity, regardless of price, largely because of concerns about cost, long-term affordability and treatment discontinuation, according to a report from Pharmaceutical Strategies Group. The report also found growing interest in unbundled pharmacy benefit manager models as organizations seek greater transparency and control over rising drug costs.

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