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Weekly Update: Latest UnitedHealth scandal | Upcoding on the rise | COVID vaccine changes | Ransomware attack | Rite Aid sold

News You Need to Know Today
Weekly Update: Latest UnitedHealth scandal | Upcoding on the rise | COVID vaccine changes | Ransomware attack | Rite Aid sold
Saturday, May 24, 2025
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This Week’s News

Report: UnitedHealth rewarded nursing homes for delaying hospital transfers

Citing evidence from documents and interviews, the Guardian released an exposé accusing UnitedHealth of directly influencing the day-to-day operations of some 2,000 nursing homes, resulting in patients not receiving necessary emergency care.

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Report: UnitedHealth rewarded nursing homes for delaying hospital transfers

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UnitedHealthcare HQ Sign
Citing evidence from documents and interviews, the Guardian released an exposé accusing UnitedHealth of directly influencing the day-to-day operations of some 2,000 nursing homes, resulting in patients not receiving necessary emergency care.
READ MORE >

Upcoding on the rise across all outpatient settings, study finds

A report by researchers at Trilliant Health found that common symptoms—such as cough, nausea and rash—are often coded as complex medical events, resulting in higher reimbursement rates.

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Upcoding on the rise across all outpatient settings, study finds

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healthcare surprise billing statement payment
A report by researchers at Trilliant Health found that common symptoms—such as cough, nausea and rash—are often coded as complex medical events, resulting in higher reimbursement rates.
READ MORE >

CMS vows to ramp up audits of Medicare Advantage plans

The Centers for Medicare & Medicaid Services said it will increase medical coding staff from 40 to 2,000 and begin addressing its backlog of audits on Medicare Advantage plans in an effort to spot signs of fraud and abuse. 

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CMS vows to ramp up audits of Medicare Advantage plans

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Medicare Advantage Part C clipboard payment
The Centers for Medicare & Medicaid Services said it will increase medical coding staff from 40 to 2,000 and begin addressing its backlog of audits on Medicare Advantage plans in an effort to spot signs of fraud and abuse. 
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FDA outlines stricter ‘evidence-based approach’ to COVID vaccinations

The FDA is revising its approach to COVID-19 vaccine approvals, moving away from the previous trend of treating boosters like annual flu shots. Health researcher Vinay Prasad and Commissioner Martin Makary argue in the New England Journal of Medicine for more rigorous data requirements and additional clinical studies to justify future inoculations for those under 65. 

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FDA outlines stricter ‘evidence-based approach’ to COVID vaccinations

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U.S. FDA Sign
The FDA is revising its approach to COVID-19 vaccine approvals, moving away from the previous trend of treating boosters like annual flu shots. Health researcher Vinay Prasad and Commissioner Martin Makary argue in the New England Journal of Medicine for more rigorous data requirements and additional clinical studies to justify future inoculations for those under 65. 
READ MORE >

Nursing homes fined $15M for staffing fraud after guilty verdict

The U.S. Department of Justice announced the judgment, which was issued against two facilities in Pennsylvania. The nursing homes fraudulently billed Medicare and Medicaid for working hours despite staff not being on the floor. 

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Nursing homes fined $15M for staffing fraud after guilty verdict

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The U.S. Department of Justice announced the judgment, which was issued against two facilities in Pennsylvania. The nursing homes fraudulently billed Medicare and Medicaid for working hours despite staff not being on the floor. 
READ MORE >

Small pharmacies stockpile drugs as tariff fears grow

KFF Health News interviewed multiple independent pharmacies for a new report, detailing their basements full of generic and specialty drugs as a hedge against supply shocks. 

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Small pharmacies stockpile drugs as tariff fears grow

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artificial intelligence pharmaceutical industry
KFF Health News interviewed multiple independent pharmacies for a new report, detailing their basements full of generic and specialty drugs as a hedge against supply shocks. 
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Tom Price: Medical residency slots need to expand to combat physician shortages

Tom Price, MD, former secretary of Health and Human Services (HHS), said one way to address the growing shortage of physicians is to expand medical resident positions, but these are tied to Medicare spending so alternative means may be needed.

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Tom Price, MD, an orthopedic surgeon and former secretary of Health and Human Services (HHS) during the first Trump administration, said one way to address the growing shortage of physicians is to expand medical resident positions, but these are tied to Medicare spending so alternative means may be needed.
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Tom Price: Medical residency slots need to expand to combat physician shortages

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Tom Price, MD, an orthopedic surgeon and former secretary of Health and Human Services (HHS) during the first Trump administration, said one way to address the growing shortage of physicians is to expand medical resident positions, but these are tied to Medicare spending so alternative means may be needed.
Tom Price, MD, former secretary of Health and Human Services (HHS), said one way to address the growing shortage of physicians is to expand medical resident positions, but these are tied to Medicare spending so alternative means may be needed.
READ MORE >

Ransom demanded, emergency care diverted as Kettering Health reels from cyberattack

The Ohio-based nonprofit health system did not confirm patient data was exposed and taken by hackers. However, a media report confirmed it has received a ransom notice credited to the Interlock cybercrime cell. 

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Ransomware Cyberattack Data Breach
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Ransom demanded, emergency care diverted as Kettering Health reels from cyberattack

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Ransomware Cyberattack Data Breach
The Ohio-based nonprofit health system did not confirm patient data was exposed and taken by hackers. However, a media report confirmed it has received a ransom notice credited to the Interlock cybercrime cell. 
READ MORE >

Patient sues surgeon and Allina Health for allegedly removing the wrong organ during surgery

In court documents, an unnamed Minnesota woman said that in 2022, she was admitted to an Allina Health hospital and scheduled for the removal of her infected spleen, only for an error to result in her left kidney being removed instead.

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Patient sues surgeon and Allina Health for allegedly removing the wrong organ during surgery

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doctor wrong patient wrong-site surgery medical error malpractice mistake
In court documents, an unnamed Minnesota woman said that in 2022, she was admitted to an Allina Health hospital and scheduled for the removal of her infected spleen, only for an error to result in her left kidney being removed instead.
READ MORE >

Rite Aid sells over 1,000 pharmacies to competitors, including CVS and Walgreens

The deals account for most of Rite Aid’s remaining stores, as the bankrupt chain nears its final days.

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Rite Aid sells over 1,000 pharmacies to competitors, including CVS and Walgreens

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The deals account for most of Rite Aid’s remaining stores, as the bankrupt chain nears its final days.
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