The Massachusetts attorney general sued UnitedHealthcare, alleging the insurer improperly inflated MassHealth members’ health risk scores to secure at least $100 million in excess payments. The post Massachusetts Attorney General Sues UnitedHealthcare, Alleges $100M MassHealth Fraud appeared first on MedCity News.

A fragmented system built on isolated metrics like BMI and A1C fails to capture the full picture of metabolic health and limits our ability to manage it effectively. The post Are We Measuring Metabolic Health All Wrong? appeared first on MedCity News.

By adopting interpretation-driven, clinically intelligent technologies, revenue cycle teams can ensure that every nuance of care is accurately represented. This safeguards revenue integrity while maintaining the highest standards of compliance. The post Scaling AI in Health Systems: From Innovation to Sustainable Implementation appeared first on MedCity News.

Every month a legitimate workflow improvement sits in queue, the organization pays for the problem twice: once in the inefficiency the change was supposed to fix, and again in the workaround everyone built to get through the week. The backlog doesn’t show up as a line item. It shows up everywhere else.  The post The Most Expensive Queue in Healthcare Isn’t Prior Auth — It’s the IT Backlog appeared first on MedCity News.

While there are growing efforts to link dental health with overall health, the urgency should be felt strongly not only by pregnant women but, more importantly, by their care providers and health insurance companies. For instance, pregnant women with gum disease are 3-4 times more likely to develop pre-eclampsia, an emergency condition. The post Why Ob-Gyns, States, and Plans, Should Care About Oral Health appeared first on MedCity News.

Regeneron Pharmaceuticals’ multiple myeloma drug linvoseltamab has clinical trial results showing complete responses in 90% of patients who have light chain amyloidosis, a rare blood disease. The preliminary data were presented during the annual meeting of the American Society of Clinical Oncology. The post Regeneron Cancer Drug Shows New Promise in a Rare Disease… and Maybe More appeared first on MedCity News.

Signos raised $20 million to expand its glucose monitoring platform for weight loss, which pairs Dexcom’s over-the-counter CGM with an app that translates glucose data into personalized diet and lifestyle recommendations. The post Signos Secures $20M to Expand CGM Use Beyond Diabetes Into Weight Loss appeared first on MedCity News.

Health tech companies made several major funding announcements in May. Here is a list of some of the biggest funding rounds. The post 4 Notable Health Tech Funding Announcements in May appeared first on MedCity News.

Providing access to GLP-1s only solves part of the problem. In fact, without a broader approach, it may lead to new challenges alongside the ones it aims to address. The post Telehealth is Making GLP-1s More Accessible – But Access Alone isn’t Enough appeared first on MedCity News.

The real question is whether we’re being honest with ourselves about what medical education was designed to produce, and whether our current system is still doing that job. The post Medical Education Is at a Crossroads. AI Isn’t the Problem — It’s the Mirror appeared first on MedCity News.

The rise of metabolic gene therapies represents a critical juncture for benefits management. These treatments offer genuine hope for patients with serious conditions, but they also pose significant financial challenges.  The post Preparing Benefits For the Next Wave: Gene Therapy Medications appeared first on MedCity News.

May has seen a slew of executive hires, exits and layoffs across the healthcare industry. For instance, Abridge, Highmark Health and Merck named new executives. There were also layoffs at organizations including Innovaccer, Intermountain Health and Novartis. The post Healthcare Moves: A Monthly Summary of Hires, Exits and Layoffs appeared first on MedCity News.

Pfizer unveiled a multi-drug R&D collaboration with Innovent Biologics, making it the latest big pharma company to reach a deal that taps into Chinese labs to source biotech innovation. This alliance will focus on developing next-generation drugs in the class of targeted cancer therapies called antibody drug conjugates. The post Pfizer’s $10.5B Deal With One of China’s Top Cancer Biotechs Is Another Sign the Game is Changing appeared first on MedCity News.

Garner’s Series E round was led by Index Ventures with participation from Kleiner Perkins, Redpoint, Thrive, Sequoia, Founders Fund and Kaiser Permanente Ventures. The post Garner Health Secures $100M to Connect Patients with High-Performing Doctors appeared first on MedCity News.

The next evolution in digital health is layering intelligent orchestration on top of the EHR to activate care in real time. It’s a platform plus orchestration layer, powered by AI and designed for action. The post The EHR Was Built to Store Data — It Wasn’t Built to Orchestrate Care appeared first on MedCity News.