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Louisiana Moves to Rein in AI Use in Coverage Denials

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Louisiana lawmakers are advancing legislation that could significantly change how artificial intelligence is used in payer decision-making—particularly when it comes to denying coverage. The proposed bill would require that any denial involving AI or automated systems be reviewed and approved by a qualified human clinician, ensuring decisions are based on individualized patient circumstances rather than algorithms alone. If enacted, the policy would roll out in phases beginning in August 2026, eventually applying to all new…
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Court Orders UnitedHealth to Release Documents in AI Denial Lawsuit

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A federal judge in Minnesota has ordered UnitedHealth Group to produce extensive documentation in an ongoing lawsuit alleging improper use of AI in Medicare Advantage coverage decisions. The case centers on the use of nH Predict, a tool developed by the company’s Optum division (formerly naviHealth), which plaintiffs claim contributed to premature denials of post-acute care—particularly skilled nursing services. The lawsuit, filed by families of two deceased patients, argues that the tool may have overridden…
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Aetna to Pay $117.7M to Settle Medicare Advantage Coding Allegations

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Aetna has agreed to pay $117.7 million to resolve federal allegations that it improperly inflated Medicare Advantage payments by submitting inaccurate diagnosis codes and failing to correct them when unsupported by medical records. The settlement, brought under the False Claims Act by the U.S. Department of Justice, centers on risk-adjustment practices used to determine payments from the Centers for Medicare & Medicaid Services (CMS). Under this model, insurers receive higher payments for members with more…
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UnitedHealthcare Expands Doula Coverage to Support Maternal Health Outcomes

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UnitedHealthcare has announced a nationwide expansion of doula coverage for eligible employer-sponsored and commercial plans, marking one of the greatest efforts of its kind in the private insurance market. The phased rollout, beginning in 2026, could reach approximately 7.2 million members by January 1, 2027, depending on employer participation. Coverage options may include a set number of doula visits or reimbursement allowances, with services available both in-person and virtually. Members may also have flexibility in…
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Deadline Reminder: ACO Quality Data Submission for 2025 Performance Year

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The Centers for Medicare & Medicaid Services (CMS) is reminding Medicare Shared Savings Program Accountable Care Organizations (ACOs) that the Quality Payment Program (QPP) data submission deadline is quickly approaching. All quality data for the 2025 performance year must be submitted by March 31, 2026, at 8:00 PM ET. ACOs are encouraged to carefully review their submissions for completeness and accuracy prior to the deadline, as changes or corrections will not be allowed once the…
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CMS Updates QPP Resources and Announces Upcoming MIPS Cost Measure Webinars

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The Centers for Medicare & Medicaid Services (CMS) has released updates to key resources within the Quality Payment Program (QPP), while also inviting stakeholders to participate in upcoming discussions future cost measure development under MIPS. CMS recently updated the 2026 Qualified Clinical Data Registry (QCDR) and the 2025–2026 Qualified Registry postings, reflecting changes such as remedial actions and terminations affecting certain third-party intermediaries. Providers and organizations are encouraged to review the latest versions—along with the…
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3 Emerging Trends Adding Pressure on Anesthesiology Teams

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Recent research is highlighting several growing challenges for anesthesiologists, from evolving patient needs to workforce instability—trends that could impact both clinical care and operations. Together, these trends reflect increasing pressure on anesthesiology teams, emphasizing the need for improved workflows, stronger collaboration, and proactive workforce planning. Resource: 3 studies scaring anesthesiologists

Audit Finds Potential Medicare Advantage Overpayments for BCBS Alabama

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A recent audit from the HHS Office of Inspector General (OIG) estimates that Blue Cross Blue Shield of Alabama may have received at least $7 million in Medicare Advantage overpayments. The findings are based on a review of 271 enrollee-years, where the majority showed discrepancies between submitted diagnosis codes and supporting medical records. These inconsistencies led to approximately $769,000 in identified overpayments within the sample, which OIG used to project the larger total. The audit…
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States Move to Regulate AI in Coverage Decisions, Emphasizing Human Oversight

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Lawmakers in both Louisiana and Georgia are advancing legislation that would limit how artificial intelligence is used in health insurance coverage decisions—signaling a broader push to ensure clinical judgment remains central in patient care. In Louisiana, proposed legislation would require that any denial, delay, or modification of care involving AI must include independent human review. A qualified clinician would need to evaluate the case and, in many instances, a physician would be required to personally…
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Rising Measles Cases in the U.S. Highlight Growing Public Health Concerns

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New data from the Centers for Disease Control and Prevention shows a continued rise in measles cases across the United States, with totals climbing into the 1,300–1,400+ range as of mid-to-late March 2026. Recent updates noted at least 1,362 confirmed infections, with numbers continuing to increase to 1,487 cases by March 19. The majority of these cases are tied to outbreaks, with 14 identified so far in 2026 and approximately 94% of cases linked to…
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CMS Moves Toward Fully Electronic Claims Processing, Reducing Administrative Burden

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The Centers for Medicare & Medicaid Services (CMS) has finalized a new rule aimed at modernizing how healthcare providers submit claims documentation—replacing outdated methods like faxing and mailing with standardized electronic transactions. At the core of this update is the adoption of national standards for electronic claims attachments and secure electronic signatures. These changes are designed to simplify how providers share supporting documentation—such as medical records, lab results, and clinical notes—with health plans. By creating…
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Ipsen Withdraws Cancer Drug Tazverik from U.S. Market Over Safety Concerns

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Ipsen is voluntarily removing its cancer therapy Tazverik from the U.S. market due to safety concerns. An ongoing clinical trial reported secondary hematologic malignancies, serious blood cancers, suggesting that the risks may outweigh potential benefits for patients. Tazverik received accelerated approval from the FDA in 2020 to treat epithelioid sarcoma, a rare soft tissue cancer, and relapsed or refractory follicular lymphoma, a type of non-Hodgkin lymphoma. The voluntary withdrawal applies to all approved indications. Resource:…
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