From denials and payer plans for unilateral downcoding to 340B legal battles, the most-read stories of 2025 reveal a revenue cycle under pressure, and the strategies leaders are using to stay afloat.

RETHINKING STRATEGY The Philippine Institute for Development Studies calls for a shift in PhilHealth’s fraud control mechanisms from a reactive to a proactive approach. —PHOTO FROM GRIG MONTEGRANDE ...

President Donald Trump has signed an executive order making some big changes to marijuana policy, the most substantial since 1970. On Dec. 18, Trump ordered the government to stop classifying ...

When UnitedHealth Group CEO Stephen Hemsley returned to the helm of the healthcare giant earlier this year, he committed to a deep review of the company's processes in the wake of months of turmoil.

Healthcare pilot program WISeR begins Jan 1 in 6 states, including Arizona. Private for-profit contractors will use AI to decide whether Traditional Medicare (TM) patients get treatments their doctors ...

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. Dr. Thomas C. Weiner, the oncologist who was the subject of a ...

UnitedHealth is aggressively gaming Medicare Advantage to inflate its reimbursement from the federal government, according to a Senate committee investigation. That includes by sending nurses to ...

According to U.S. Centers for Medicare and Medicaid Services (CMS), as of 2023, the amount of money the average American spends on healthcare was $14,570 per person. That figure alone could be ...

Sen. John Kavanagh wants to give you a tool to do something about that. And what the Fountain Hills Republican is proposing even could net you a $5,000 reward. SB 1036 seeks to expand existing laws ...

Second, the DOJ's Criminal Division included healthcare fraud as one of its ten priority "high-impact" areas for 2025. This was quickly followed by the largest healthcare fraud takedown in DOJ history ...

The last time the law was used was in the 1990s. President Donald Trump threatened to invoke the Insurrection Act to send in federal troops as protests unfold in Minneapolis against Immigration and ...