Weekly Update: CMS sued over Medicare AI | 'Ghost network' lawsuit | UnitedHealthcare AI companion | Physician burnout report

The Electronic Frontier Foundation, a nonprofit digital civil rights advocacy group, said it filed a Freedom of Information Act request seeking more information about the “WISeR” pilot program, which effectively adds a prior-authorization process to traditional Medicare in six states. To date, it’s received no response. 

In total, 131 hospitals are acting as plaintiffs. They’re asking a court to throw out 2023 changes to the Disproportionate Share Hospital calculation that altered the way Medicare Advantage and Social Security income were factored into the risk-adjusted payments hospitals receive for caring for vulnerable patient populations.

On Tuesday, a judge formally rejected a motion by the company to have the case dismissed. Carelon Behavioral Health, a subsidiary of Elevance, is accused of publishing an inaccurate directory of providers for those seeking mental health services.

The new agentic program, called “Avery,” is now available to millions of UnitedHealthcare members through insurer's existing app. The company said the model will help patients find providers, understand their benefits, get updates on claims and more.

In a statement, Nacogdoches Memorial Hospital said the incident occurred on Jan. 31. Stolen information included names, medical record numbers, Social Security numbers and more. No cybercrime gang has claimed credit for the data breach.

In a complaint filed in federal court, the U.S. Department of Justice claims NewYork-Presbyterian Hospital uses its power of “scale, breadth and configuration” to control payer contracts, making it difficult for insurers to develop low-cost plans. The health system denies any wrongdoing.

The cloud infrastructure company said in a recent investor meeting that its heavy spending on AI has been complicated by the global GPU and CPU shortage. Some 10,000 workers have reportedly been laid off, but the true number is unknown.

It’s unclear why Tallahassee Memorial HealthCare dropped its lawsuit, but it did so with prejudice, meaning the hospital cannot refile. There are many unanswered questions surrounding the unusual case, including how common incidents like this are and whether or not the hospital can technically bill for the time the room was occupied.

Republicans are said to be considering cuts to cost-sharing programs through the Affordable Care Act as a means to save money and fund the U.S. Department of War, which is looking for $200 billion to cover not only the conflict in Iran but also domestic immigration enforcement.

Three-fifths of 14,000 physicians surveyed, 60%, enjoy a strong sense of belonging within their organization. Better yet, four-fifths, 80%, feel their teammates have their back.