The Department of Justice said in a memo that home health and hospice fraud is an area of focus for its National Fraud Enforcement Division, citing significant losses in the nation's healthcare system. The DOJ also said the division will have about 500 attorneys by Aug. 24 and will continue to grow over the next two years

The 5th US Circuit Court of Appeals unanimously ruled that Planned Parenthood must face a $1.8 billion Medicaid fraud lawsuit filed by Texas and rejected its immunity bid, allowing the case to proceed. The lawsuit alleges that Planned Parenthood collected funds from Texas' and Louisiana's Medicaid programs after the states cut off funding.

Six Ohio Medicaid providers have been indicted on charges of defrauding over $500,000 from the program. The providers have been charged with falsifying timesheets and billing for services that weren't provided, with individual losses ranging from $4,510 to $404,810.

AI is playing a major role in influencing consumer choices for Medicare Advantage plans, with half of searches being done across five AI platforms, according to a report from 5WPR that ranked 25 MA plans based on AI searches. UnitedHealthcare, Humana and Kaiser Permanente were the top three insurers AI named first, meaning insurers that have AI-retrievable authority have the potential to gain the most members.

A CMS decision not to renew Arkansas' Medicaid waiver signals potential widespread changes as the government implements new budget neutrality rules. Arkansas' 13-year-old waiver allows the state to buy Affordable Care Act exchange plans for adults eligible for expanded Medicaid coverage. The CMS determined that the program costs more than Medicaid would and thus doesn't comply with the budget neutrality rules. Georgia and California also have waivers expiring this year. Many long-standing waivers are at risk for non-renewal, says Robert Nelb, director of policy at America's Essential Hospitals.

A KFF analysis of new federal prior authorization data found variations in how insurers handle requests across Medicare Advantage, Medicaid and Affordable Care Act markets. The data showed insurers denied at least 1 in 8 standard prior authorization requests last year, with denial rates ranging from 2% to 25%.

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