VAB RCM

09/06/2026

About 1 in every 5 eligible adults in Medicaid expansion states might lose their benefits due to new work requirements that take effect in 2027, a new study says. These folks likely will be unable to fulfill the minimum work hours required under the new law,

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08/29/2026

Medicare Advantage coding enforcement is becoming a very serious financial risk. On August 28, The Villages Health agreed to a $541.5 million settlement over allegations that unsupported diagnosis codes were submitted and thereby increased Medicare Advantage payments. This is directly relevant to coding, risk adjustment, compliance audits, and billing documentation.

The settlement resolves allegations that the Humana-owned provider submitted unsupported diagnosis codes that increased federal payments.

08/17/2026

The latest available U.S. data (July 2026) for the major inflation and medical-cost indexes comparison. Can medical billing beat inflation?

The July numbers show that headline inflation eased very slightly: CPI rose 0.1% in July and 3.4% year-on-year, down from 3.5% in June. Core inflation, excluding food and energy, rose 0.2% month-on-month and 2.5% year-on-year. Energy remains unusually inflationary, up 14.7% from July 2025, although energy prices actually fell 1.5% during July.

Medical prices moved rather differently from the general index. The broad medical-care CPI increased 0.4% in July alone, after falling 0.1% in June. Within medical care, hospital services rose 0.5% in July, physicians' services rose 0.2%, while prescription-drug prices fell 0.8%. Medical-care services as a whole rose 0.6% in July and 2.7% over the preceding 12 months. The broader medical-care index was up 1.7% year-on-year.
So there is an interesting distinction: medical care overall is currently rising more slowly year-on-year than general CPI (1.7% versus 3.4%), but medical-service prices accelerated sharply in July, particularly hospital charges. Medical-care commodities, by contrast, were actually 2.7% cheaper than a year earlier and fell 0.6% in July.

There is also a longer-running hospital-cost problem that the headline medical CPI partly conceals. PwC's latest 2026 analysis reports that hospital and related-services inflation reached 7.59% year-on-year in February 2026, a post-pandemic high. In other words, the amount ultimately charged or negotiated for hospital care can be rising substantially faster than the broad consumer medical-price index.

08/08/2026

GEICO alleges four New York medical-supply firms ran a fast-moving billing operation, charging more than $2.9 million in four months for equipment it says was cheap, unneeded or never delivered.

In a complaint filed August 6, 2026 in the Eastern District of New York, the insurer alleges that four supply companies served as the billing arm of a "quick hit" scheme targeting New York's No-Fault system. According to the filing, the companies took turns dispensing durable medical equipment and orthotic devices - lumbar-sacral supports, osteogenesis bone stimulators, orthopedic pillows and massagers - to people said to have been injured in car accidents, then billed GEICO and other auto insurers.

GEICO alleges the firms were owned "on paper" by four individuals, each of whom, the filing says, "is not and has never been a licensed healthcare provider." The real control and profit, the complaint alleges, sat with an unidentified operator it calls the "Secret Owner," named as a John Doe defendant, for whom the paper owners are said to have worked.

Four rotating supply firms, vague scripts, inflated codes - GEICO says it paid before catching on

07/29/2026

Surprise billing isn’t going away — the trend is that the patient is being protected, while insurers and providers are now locked in a growing legal battle over who gets paid and how much.

Air ambulance teams train to respond to car accidents on remote highways, cardiac arrests, and children who stop breathing. When the call comes, they go because air medical transport exists to reach

07/16/2026

Medicare is proposing a major change in the way doctors are paid. The idea is to reward primary care, prevention and long-term results instead of simply paying more for every visit, test and procedure. On paper, that sounds reasonable: the American healthcare system spends heavily on expensive treatment after people become seriously ill, while family doctors and preventive care remain badly underfunded.

But the proposal also cuts payments and increases pressure on doctors to control costs. That means “better outcomes” could easily become a bureaucratic excuse for spending less, limiting treatment and forcing small independent practices out of business. So this may look like a public-health reform, but unless substantial new resources actually go into primary care, it risks becoming another austerity measure dressed up in the language of prevention and efficiency.

The Centers for Medicare & Medicaid Services on Tuesday proposed changes to Medicare's decades-old physician payment system, saying the updates would ​support the Trump administration's push to emphasize primary and preventive ‌care rather than treatment after patients become ill.

07/08/2026

The Medical Tourism Association, a non-profit that helps promote and facilitate medical tourism, estimated the global industry to be worth more than $100 billion as of 2024 and growing at an annual rate of 15 to 25%.

The financial incentive in becoming a medical tourism destination is evident in South Korea, which welcomed more than 2 million foreign patients last year, its third consecutive record-breaking year. Those tourists and their companions spent more than $8 billion and generated more than $15 billion in domestic production, according to the Korea Institute for Industrial Economics and Trade.

Visitors from the United States, the largest cohort after those from China, Japan and Taiwan, increased by 70.4% to 173,363 patients year on year, the nation’s Ministry of Health and Welfare said.

As medical technology in the region improves, and western healthcare costs climb, other nations including China, Vietnam and the Philippines are competing to rebrand themselves as medical tourism hubs too. Executives at medical facilities in Asia said their success will likely hinge on marketing and government efforts to appeal to patients overseas.

Nations like China, Vietnam and the Philippines are trying to attract more medical tourists to boost local economies as wait times and costs elsewhere climb.

07/02/2026

Greetings from VAB RCM! May our republic prosper!

07/01/2026

First of major coverage losses expected as a result of the ‘One Big Beautiful’ bill signed into law one year ago

Nearly 500,000 moderate-income New Yorkers will be dumped from their health insurance plans on 1 July – the first of major coverage losses expected as a result of HR 1, the Republican-led law signed almost exactly one year ago.

The law, sometimes called the “One Big Beautiful Bill Act,” slashed government health spending by $911bn nationally in favor of permanent tax breaks for higher-income families and border security.

“It’s an all hands on deck situation,” said Maia Dillane, senior director of strategy and implementation at the Arab-American Family Support Center (AAFSC), based in New York City, where the bulk of this summer’s coverage losses are expected.

The AAFSC is one of 20 community-based organizations working with the Community Service Society of New York to find people new health coverage.

First of major coverage losses expected as a result of the ‘One Big Beautiful’ bill signed into law one year ago

06/24/2026

The two-week operation uncovered more than $6.5 billion in false claims submitted to insurers, according to the Department of Justice. State authorities made nearly two dozen arrests.
More than two dozen people from Florida were among 455 individuals charged in a $6.5 billion health care fraud and insurance scheme during a two-week federal enforcement operation, authorities announced.

Florida cases included a cardiologist accused of billing insurers for medically unnecessary screening tests for college athletes; three Tampa-area healthcare workers in a $118 million Medicare fraud involving unnecessary wound care and skin grafts; and a Miami man who directed a $3.76 billion scheme that billed Medicare, Medicaid and other insurers for phantom medical supplies.

Healthcare fraud has been a long-running priority for the Department of Justice, and news conferences announcing roundups and crackdowns have been common across the years. The Trump administration has made a point of emphasizing enforcement, including through the appointment of a new assistant attorney general, Colin McDonald, to help oversee prosecutions built from multiple specialized task forces.

“Today’s cases allege more than the theft of taxpayer dollars. Many allege the theft of human dignity,” McDonald said at a news conference Tuesday announcing this year's crackdown, which covers cases charged or unsealed since June 8. “Our sick, needy and elderly placing their faith in the gift of medicine were neglected, ignored and used for personal profit.”

The two-week operation uncovered more than $6.5 billion in false claims submitted to insurers, according to the Department of Justice. State authorities made nearly two dozen arrests.