DOJ’s Largest Health Care Fraud Takedown Ever Should Make Us Ask: Why Is Our System So Easy to Exploit?

By Wendell Potter and Joey Rettino - After a two year investigation, the U.S. Department of Justice announced what it called the largest coordinated health care fraud takedown in its history — 324 defendants charged in sweeping schemes spanning $14.6 billion in intended losses, from shady addiction treatment clinics to medically unnecessary skin grafts and catheter orders. It’s a massive win for taxpayers. But it’s also a glaring reminder that the U.S.’s fragmented, opaque and under-regulated health care system is fertile ground for fraud — whether it’s orchestrated by international criminal rings or by well-dressed executives at some of America’s largest health insurers. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Massive Fraud by Criminal Networks: Federal prosecutors exposed a $650 million Medicaid fraud scheme orchestrated by a Pakistani national, Farrukh Ali, involving dozens of fake addiction clinics in Arizona. These clinics targeted vulnerable populations, including homeless individuals and Native Americans, to bill for nonexistent or ineffective treatments — part of a larger pattern of transnational criminal exploitation of public health programs.

2. Legally Sanctioned Exploitation by Corporations: While criminal fraud grabs headlines, the article emphasizes that large health care corporations routinely engage in legally permissible practices that drain far more from the system. Medicare Advantage insurers inflate patient risk scores through “upcoding” and use selective enrollment tactics to maximize profits, while Pharmacy Benefit Managers (PBMs) manipulate pricing and rebates to extract additional revenue with little benefit to patients.

3. Systemic Vulnerability to Abuse: The U.S. health care system is described as structurally flawed, allowing both illegal and legal forms of exploitation to thrive. The article criticizes the lack of oversight and political will to regulate corporate actors, arguing that the true scandal lies not just in criminal fraud, but in the entrenched systems that enable large-scale financial abuse under the guise of health care management.

How Trump’s tax-cut bill is set to upend health care

By Danie Payne, Chelsea Cirruzzo, and John Wilkerson - The bill narrowly passed through the Senate and House earlier in the week after marathon debates, with all Democrats opposed in each chamber. The bill slashes health care spending by more than $1 trillion over a decade, cuts that will affect patients, hospitals, and doctors nationwide. It will also force states to make tough decisions about how to balance their budgets as the federal government pulls back. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Significant Medicaid Cuts and Reforms: The legislation reduces federal Medicaid funding by over $1 trillion over the next ten years, making it the largest rollback to the program in decades. It introduces a nationwide work requirement for certain adults without dependents, restricts funding streams like provider taxes and state-directed payments, and increases administrative checks that could lead to coverage losses for some enrollees.

2. Reduced Access to Affordable Care Act (ACA) Coverage: The bill imposes stricter eligibility rules for ACA premium tax credits, including ending subsidies for some lawful immigrants and requiring real-time income and status verification. It also eliminates repayment caps on premium credits and reduces incentives to enroll during special enrollment periods, which may result in fewer people maintaining consistent coverage.

3. Mixed Changes to Other Health Policies: The legislation includes varied policy shifts: it boosts rural health funding to $50 billion over five years and expands flexibility for using Health Savings Accounts (HSAs), including for telehealth and direct primary care. At the same time, it broadens exemptions for pharmaceutical companies from Medicare price negotiations and removes earlier provisions that would have restricted federal funding for gender-affirming care.

House votes 218-214 to send $3.3T tax package, with HSA provisions, to Trump

By Allison Bell -  Members of the U.S. House today voted 218-214 to approve an 870-page tax and spending package that renews many of the federal tax provisions now in place, imposes major federal health program spending cuts, could increase the federal debt by $3.3 trillion over 10 years, and includes provisions that could make health savings accounts more flexible. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Partisan Division and Narrow Passage: The "One Big Beautiful Bill Act" (OBBBA) passed the House with strong Republican backing but faced unified Democratic opposition, along with two Republican dissenters — Thomas Massie and Brian Fitzpatrick. The bill’s fate was uncertain for much of the day, and GOP leadership had to rally support to secure a floor debate, highlighting internal divisions and the controversial nature of the legislation.

2. Major Healthcare Spending Cuts: The bill includes more than $1.1 trillion in federal health program spending cuts over the next decade, targeting Medicaid, Medicare, and ACA-related subsidies. Critics argue these reductions could result in up to 17 million people losing health coverage and severely impact care access and provider stability. Supporters present the cuts as a step toward long-term fiscal responsibility, though watchdogs warn the bill may actually worsen the national debt.

3. HSA and Retirement Savings Changes: The final version of the OBBBA expands Health Savings Account (HSA) flexibility, permitting spending on direct primary care memberships, telehealth services, and pairing HSAs with a broader range of insurance plans. It also preserves key tax incentives for retirement savings and employer-provided benefits, which industry groups praised as critical for maintaining financial and health security for workers and families.

How Health Care Remade the U.S. Economy

By Lydia DePillis and Christine Zhang - For years, the United States labor market has been undergoing a structural transformation. As jobs in manufacturing have receded, slowly but steadily, the health care industry has more than replaced them. The change has been particularly visible over the past year, during which health care has been responsible for about a third of all employment growth, while other categories, like retail and manufacturing, have stayed essentially flat. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Continued Growth in Health Care Employment: The U.S. health care sector has expanded from 9% of the workforce in 2000 to 13% today, driven by an aging population, broader insurance coverage under the Affordable Care Act, and rising demand for chronic and preventive care. Health care has become the largest employer in 38 states, playing a vital economic role in both urban centers and rural communities.

2. Threats from Federal Spending Cuts: Proposed Republican legislation includes approximately $1 trillion in Medicaid cuts and $82 billion in reductions to other federal health programs over the next decade. Analysts warn that these cuts could undermine health care access, particularly in low-income and rural areas, and reduce workforce growth. Supporters frame the cuts as necessary for budget control, while experts caution about economic and public health fallout.

3. Emerging Efficiency Pressures and Technological Shifts: Despite rising demand, health care job growth may be tempered by efficiency gains, such as outpatient procedures, pharmaceutical innovations, and artificial intelligence. These trends could reduce administrative burdens and shift labor needs, prompting economists to warn against treating the sector as a catch-all jobs program given its rising share of national spending.

Health coverage regional disparities highlight impact of policy, economy

By Kristen Smithberg - Most Americans had health insurance at least part of the year in 2023, but coverage varies widely from market to market. This variability is a result of different policies, economic conditions and local job markets, according to an analysis by Visual Capitalist. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. High National Coverage: In 2023, an estimated 305 million Americans—representing about 92% of the total population—had health insurance. This indicates a strong national trend toward widespread coverage, suggesting that most people in the U.S. have access to some form of healthcare protection.

2. Regional Disparities: Several metro areas in Massachusetts, along with select cities in the Midwest, recorded the highest health insurance coverage rates in the country, with many exceeding 97%. These high levels are likely influenced by socioeconomic factors such as higher median household incomes and greater educational attainment, which are often linked to better access to health insurance.

3. Texas Coverage Lag: Most of the metro areas with the lowest rates of health insurance coverage in 2023 were located in Texas, with some cities seeing rates as low as 70.7%. The report highlights that Texas’s decision not to expand Medicaid under the Affordable Care Act, along with relatively high insurance costs, may contribute to the state’s comparatively low levels of coverage.

Sick of answering the same benefits questions from employees? Let AI do the work

By Paola Peralta - Benefit managers have utilized AI to help with everything from automating tasks, simplifying recruiting processes and streamlining benefits enrollment. A new benefit agent from Flimp is promising to help leaders answer some complex benefits questions, too. A quarter of employees are still confused about the details of their benefit packages, according to a recent survey from financial services company Voya Financial. Employees typically have access to this information, yet struggle to know where to find it. That's where AI can help guide employees to the right answers and bridge that knowledge gap. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. AI Streamlines Access to Benefits Information: Flimp’s AI-powered chatbot integrates with company websites and documents to centralize benefits information, making it easy for employees to access details about health plans, co-pays, deductibles, and policies. Instead of digging through lengthy guides, employees can ask specific questions and get quick, personalized answers that help them better understand their options.

2. Reduces Administrative Burden for HR Teams: The chatbot handles the most common and repetitive questions employees ask about benefits, freeing HR and benefits teams from constant interruptions. This automation allows HR professionals to dedicate more time to strategic work and other high-priority tasks, ultimately improving productivity and reducing burnout.

3. Safe, Customizable, and Employee-Friendly: Designed with user experience and safety in mind, the chatbot operates within a closed-circuit environment to avoid misinformation and bias. It can be tailored in name, appearance, and communication style to align with company culture, helping employees feel more comfortable and motivated to engage with their benefits information.

Study Explores Approaches to Continuous Glucose Monitoring in Primary Care

By David Raths - A study involving 76 primary care practices in Colorado explored two different approaches to initiating continuous glucose monitor (CGM) use with their diabetic patients. The study from the University of Colorado Anschutz Medical Campus was published in BMC Primary Care. Some practices chose a self-guided option using educational tools developed by the American Academy of Family Physicians. Others referred patients to a virtual CGM initiation service run by a team of primary care-based healthcare professionals who were part of the research team. Read Full Article…

HVBA Article Summary

1. Both in-house and virtual models boost CGM use: Clinics with in-house diabetes care and education specialists tended to choose a self-guided approach for initiating continuous glucose monitoring (CGM), while those without specialists preferred a virtual service. Importantly, both models were successful in increasing CGM use among patients.

2. Access to CGM can be expanded without specialists: The study demonstrated that primary care practices without in-house diabetes experts were still able to effectively offer CGM by utilizing remote support services. This suggests that innovative, flexible models can help bridge gaps in specialist access and improve diabetes care.

3. Improved diabetes care in primary settings: The findings support the use of CGM as a practical and increasingly standard tool in primary care settings. This represents a significant advancement in treatment options for the 38 million Americans living with diabetes, regardless of geographic location or clinic resources.