An audit found that Louisiana paid Medicaid managed care organizations approximately $9.6 million from February 2019 to March 2025 for coverage of more than 1,000 deceased beneficiaries. When auditors considered data from obituaries and Social Security Administration records, which the state Medicaid program does not typically use, they identified payouts for Medicaid services after beneficiaries had died. The report notes that the actual amount is likely higher, as the audit only accounted for dental coverage payments over the last eight months of the review, excluding health coverage payments.

Palmer Moland, former president of the Fairfax School District board of trustees in California, has received a sentence of time served and probation for two health care fraud cases. Prosecutors said Moland misrepresented his health status to be eligible for the In-Home Supportive Services program, resulting in overpayments totaling $78,012.55.

AI-enabled tools are increasingly being used by Medicare Advantage plans to improve error detection in risk adjustment coding. These tools can identify common coding mistakes and discrepancies in medical records, such as hierarchical condition category being reported in the wrong setting or records being merged incorrectly. By enhancing error detection, AI helps plans maintain compliance with risk adjustment data validation audits and ensure the accuracy of submitted data.

Epic is integrating AI into its EHR system to assist clinicians by providing key patient care details, enhancing note-taking and improving billing accuracy. According to Brad Fox, director of clinical informatics at Epic, AI acts as a digital workforce, offering summaries that help clinicians stay informed about patient care, even from outside their organization. The technology can extract important findings from radiology reports and translate medical jargon for patients. Future developments include AI features for test result summarization and appointment management.

Hy-Vee has partnered with Oscar Health to launch a new health insurance plan, combining Hy-Vee's retail pharmacy and care clinics with Oscar's insurance expertise. The collaboration provides affordable, accessible coverage for employees in Des Moines, Iowa, with a plan that features unlimited no-cost visits to Hy-Vee Health Exemplar Care clinics, 24/7 urgent care and exclusive Hy-Vee rewards for healthy shopping and nutrition support.

NHCAA Partner Webinars, available only to NHCAA Member Organizations, provide an opportunity to showcase your anti-fraud expertise through live training hosted on your preferred webinar platform. Partners receive and manage all registration data. NHCAA provides promotion for your webinar with two targeted emails and a spotlight on our website. For more information or to schedule a Partner Webinar, visit the Sponsorship Opportunities page on the NHCAA website or contact us at programs@nhcaa.org with any questions or ideas.

NHCAA's Platinum and Premier Supporting Members are leading providers of products and services to the health care anti-fraud industry, are valued partners who support NHCAA's mission, and have demonstrated outstanding commitment to the fight against health care fraud. Learn more about these companies on the Fraud Solutions Directory.