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FDA Issues Warning Over Misleading Claims About Cancer Drug Anktiva

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The U.S. Food and Drug Administration has issued a warning letter to ImmunityBio and its founder, Patrick Soon-Shiong, regarding promotional statements made about the cancer drug Anktiva. According to regulators, comments made in a podcast and television advertisement suggested the drug could treat, cure, or even prevent multiple types of cancer—claims the FDA says are misleading and not supported by current approvals. While Anktiva received FDA approval in 2024 for a specific type of bladder…
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Maryland Cracks Down on Cigna’s Automatic Downcoding Policy

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The Maryland Insurance Administration has fined Cigna $80,000 and ordered the insurer to halt its use of automatic downcoding for certain evaluation and management (E/M) claims, citing violations of state law and concerns over payment delays. Cigna’s policy allowed adjustments to higher-level E/M codes—such as 99204–99205, 99214–99215, and 99244–99245—if documentation did not meet specific complexity criteria. However, regulators determined that instead of automatically reducing claim levels, insurers must formally dispute questionable claims and request additional…
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Severe Infections in Older Adults Linked to Increased Dementia Risk

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New research published in PLOS Medicine suggests that serious infections in older adults may play a more direct role in the development of dementia than previously understood. The study found that conditions such as Urinary tract infection and other bacterial infections requiring hospital treatment were associated with a higher risk of developing dementia later in life. Analyzing decades of health data, researchers identified multiple conditions linked to increased dementia risk—but notably, infections remained a significant…
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Tirzepatide Shows Lower Cardiovascular Risk Compared to Dulaglutide in Type 2 Diabetes

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New findings published in Diabetes Care highlight meaningful differences in cardiovascular outcomes among commonly prescribed diabetes therapies. Researchers found that tirzepatide—marketed as Mounjaro—was associated with a lower risk of major cardiovascular events compared to dulaglutide (Trulicity) in adults with type 2 diabetes and existing cardiovascular disease. The study analyzed real-world data from a large national database, comparing outcomes across multiple GLP-1–based therapies. While tirzepatide demonstrated a reduced rate of cardiovascular events versus dulaglutide, researchers found…
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UAB Expands Access with Planned Freestanding Emergency Department in Oxford

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UAB Health System is continuing its expansion of community-based care with plans to develop a third freestanding emergency department—this time in Oxford, Alabama. The project is currently in the early stages, with a letter of intent submitted to the Alabama State Health Planning and Development Agency to obtain necessary approvals. The proposed facility would be a joint effort between UAB, the city of Oxford, and Oxford Health Systems, reflecting a collaborative approach to addressing growing…
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10 Recent Healthcare Billing Fraud Cases Highlight Ongoing Enforcement Trends

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Recent enforcement activity across the healthcare industry underscores continued scrutiny around billing practices, particularly involving telemedicine, durable medical equipment (DME), and medical necessity. Here’s a high-level look at 10 notable cases reported since early March, ranked by scale and impact: 1. $59.9M Medicare DME Fraud Scheme (Texas)A Texas individual received a lengthy prison sentence for involvement in a massive scheme billing Medicare for medically unnecessary equipment—one of the largest cases in this group. 2. $12.5M…
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CLFS Reporting Requirements Begin May 1: What Labs Need to Know

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Clinical laboratories subject to the Clinical Laboratory Fee Schedule (CLFS) should prepare for the upcoming data reporting period beginning May 1, 2026. This requirement applies to independent labs, physician office labs, and hospital outreach laboratories that meet the criteria of an “applicable laboratory” under federal guidelines. The reporting window runs from May 1 through July 31, 2026, and is based on data collected between January 1 and June 30, 2025. Laboratories will need to submit…
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Study Suggests Methylphenidate May Lower Psychosis Risk in Children with ADHD

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New research highlights important insights into the long-term safety of commonly prescribed ADHD medications. A study published in JAMA Psychiatry found that methylphenidate—widely used in treatments like Ritalin and Concerta—does not increase the risk of psychosis in pediatric patients and may even offer protective benefits when used over time. Researchers analyzed health data from nearly 4,000 children and adolescents diagnosed with ADHD and found no increased risk of psychosis among those treated with methylphenidate compared…
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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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