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CMS mandates state Medicaid directors to validate providersindustry

CMS mandates state Medicaid directors to validate providers

CMS mandates state Medicaid directors to validate providers The latest crackdown on Medicaid fraud directs states to submit a plan within 30 days on a provider revalidation strategy. Medicare & Medicaid By Susan Morse , Executive Editor | May 1, 2026 | 11:17 AM Photo: Alex Wong/Getty Images Centers for Medicare and Medicaid Services Administrator Mehmet Oz has sent state Medicaid directors a letter mandating they submit a plan within 30 days on a two-year provider revalidation strategy.CMS wants to ensure that only legitimate, qualified providers are enrolled and participating in Medicaid, Oz said in the April 23 letter.Oz made the announcement public at Politico‘s Health Care Summit on April 21.“We’re asking the states to own that problem… red and blue, all of them,” Oz said at the Politico summit. “If you don’t take it seriously, it indicates to us that we might have to take the audits… more aggressively.” CMS is reportedly aiming its initiative at home-based and other providers rather than hospitals, but Oz makes no differentiation in the letter. The question becomes whether states will need to re-screen providers that federal programs have already vetted, according to Beckers.The latest CMS initiative follows a Medicaid crackdown on fraud in Minnesota and letters sent to California, Florida, Maine and New York alleging fraud in their Medicaid programs.While CMS recognizes that most Medicaid providers are “honest, hardworking and dedicated to rendering high-quality care to beneficiaries," Oz said in the letter to state Medicaid directors, national trends “strongly suggest a persistent and growing Medicaid threat posed by sophisticated actors knowingly exploiting these complex systems for financial gain.” State Medicaid directors are to undertake a “swift revalidation of high-risk providers within 10 days of receipt of the letter and submit a comprehensive two-year strategy within 30 days; and provide a strategy results upon completion

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Cigna to exit Affordable Care Act marketindustry

Cigna to exit Affordable Care Act market

Cigna to exit Affordable Care Act market CEO David Cordani is stepping down in July. Accounting & Financial Management By Susan Morse , Executive Editor | April 30, 2026 | 11:20 AM COO Brian Evanko (left) will succeed CEO David Cordani as head of The Cigna Group. Photo: Courtesy of Cigna Cigna Group Chair and CEO David Cordani opened the company’s Q1 earnings call by saying it was “bittersweet” since this was his last quarterly earnings call.Cordani, who has led the company for 17 years, is stepping down in July and will serve as executive chair.Brian Evanko, Cigna’s president and COO, will succeed him.Cigna announced it was exiting the Affordable Care Act market at the end of the year.The primary drivers for the decision, Evanko said, was Cigna’ inability to see a clear path forward within the size of the company’s ACA business. Also, the exit will allow Cigna to focus on specialty care services and its commercial health insurance market, he said.Cigna will support its ACA members through the transition into 2027, he said.The exit will affect 396,000 members with Cigna coverage, Forbes said.This year, Cigna offered ACA coverage in 11 states and in 357 counties, expanding to include an additional 20 new counties, the company said in 2025.December 2025 marked the end of the enhanced premium tax credits in the ACA market, which increased premium costs for plans. Many consumers switched from silver tiered plans to more affordable bronze plans.An estimated 14% of ACA members simply didn’t pay their premium in January. Sicker consumers kept their coverage, leading to a deterioration in the risk pool and questions for insurers over future ACA pricing."The general expectation is that these changes could dramatically shrink the size of the individual market," said a Wakely Consulting Group report. FINANCIALSThe Cigna Group's adjusted income from operations for first quarter 2026 was $2.1 billion, or $7.79 per share, compared with $1.8 billion, or $6.

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How can businesses make sovereign cloud a reality?industry

How can businesses make sovereign cloud a reality?

Share Copy Link Share on X Share on Linkedin Share on Facebook Digital sovereignty has become an issue for companies said to be over reliant on foreign cloud providers. Photo credit: AI generated image via Shutterstock Sovereign cloud is constantly being debated, defined, and then re-defined. While the conversation has matured in recent months, the execution of sovereign cloud has lagged, and that gap is now becoming a pressing problem for organisations. Sovereign cloud isn’t just a niche concern. The term is consistently showing up in procurement requirements, regulatory reviews and strategic transformation programmes. Governments, financial institutions, healthcare providers and enterprises in critical sectors like energy, telecoms and defence, are already implementing sovereign cloud as a necessary requirement. Underpinning this heightened focus on sovereignty is a backdrop of geopolitical uncertainty, and evolving regulations, that are moving organisations towards an approach of stronger accountability and stricter data governance. Treating sovereignty as a distant goal rather than an operational priority in this context is unsustainable. It is time to move beyond simple sovereign cloud considerations and ask the harder foundational questions that a true sovereign cloud strategy demands. Sovereignty by design The issue here isn’t a lack of awareness. Most organisations understand why sovereignty matters. The problem is that many still reduce sovereign cloud to a question of data location. Treating sovereignty as a compliance layer applied after deployment creates gaps that a “sovereign-by-design” approach helps to avoid by embedding control across three core areas of sovereignty: data, operational and technology. Data sovereignty helps enable data to remain within the right jurisdiction and to be protected through strong contractual and security measures, such as customer-controlled encryption keys. Operational sovereignty means personnel who work under the corr

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Humana teams with Mark Cuban's Cost-Plus Drug Companyindustry

Humana teams with Mark Cuban's Cost-Plus Drug Company

Humana teams with Mark Cuban's Cost-Plus Drug Company The partnership for a new employer-based program design will lower patient cost by streamlining patient onboarding and automating benefit checks. Pharmacy By Susan Morse , Executive Editor | April 29, 2026 | 11:22 AM Photo: Kinga Krzeminska/Getty Images Humana's CenterWell Pharmacy has teamed with the Mark Cuban Cost Plus Drug Co. on a new employer-based program.Cost Plus Drugs has selected CenterWell Pharmacy as a pharmacy partner. Its digital pharmacy software-as-a-service (SaaS) platform, SwiftyRx, will be used by CenterWell Pharmacy for medication order operations. The partnership will lower patient costs by streamlining patient onboarding, automating benefit checks and reducing cost-to-fill, Humana said. This will be done through the combination of technology, Cost Plus Drugs' low prices, and CenterWell's distribution network and operational efficiency. The SwiftyRx platform is expected to enable CenterWell Pharmacy to offer home delivery pharmacy services to employees enrolled in the Humana Associate Benefit Plan."Today's announcements reflect an aligned mission to redesign access and affordability in a simplified approach to help patients get the medications they need," said Bethanie Stein, Pharm.D., president, Pharmacy at Humana, including CenterWell Pharmacy."Everyone should be able to get safe, affordable medication," said Mark Cuban, co-founder of Cost Plus Drugs. "This collaboration gives Cost Plus Drugs the chance to support more consumers. We're working with CenterWell Pharmacy because we trust the team and like what they're doing in trying to improve prescription affordability."  Email the writer: [email protected]   Topic: Accounting & Financial Management, Mergers & Acquisitions, Operations, Pharmacy

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Humana on track for 25% growth in Medicare Advantage membershipindustry

Humana on track for 25% growth in Medicare Advantage membership

Humana on track for 25% growth in Medicare Advantage membership Margin improvement and MA member retention are doable, as are top-quartile star-rating results in 2028, the company said. Accounting & Financial Management By Susan Morse , Executive Editor | April 29, 2026 | 11:05 AM Photo: Peter Blottman Photography/Getty Images Humana expects Medicare Advantage membership growth of 25% this year, driven in large part by the retention of existing members, said President and CEO Jim Rechtin during Wednesday's Q1 earnings call.Humana – which has a dominant presence in the MA market, rivaled only by UnitedHealthcare – is looking for margin growth of 3%. This would be a doubling of the current MA margin.The company is focused on retaining members, Rechtin said, adding that "churn is expensive."Humana has made adjustments to benefits to allow for margins during a time of high medical utilization by members. Benefits are being adjusted to have the least impact on what's important to them, he said.The resulting financial challenges led MA insurers to cut their footprint, including Humana. The company reduced its footprint from 89% of counties in 2025 to 85% in 2026. It has MA plan offerings in 46 states and Washington, D.C.For greater efficiency, Humana is centralizing certain teams and automating some processes."Right now, we are turning our attention to bids," Rechtin said. Bids for the 2027 plan year are helped by the Centers for Medicare Services change on MA rates. Insurers got a 2.5% increase, rather than the proposed 0.09% increase in the Advance Notice.Rechtin expressed appreciation to CMS on rates that he said would promote more stability in the industry. Nevertheless, he said, the medical cost continues to trend higher. Humana's net income for the quarter fell to $1.18 million from $1.24 million during the same quarter in 2025. Revenues for Q1 were $39.6 million, compared with $32.1 million in Q1 of 2025. Financials beat Wall Street expectations.

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Arm launches Performix toolkit for AI workload optimisationindustry

Arm launches Performix toolkit for AI workload optimisation

Share Copy Link Share on X Share on Linkedin Share on Facebook Arm’s Performix toolkit integrates performance optimisation with automated AI development. Credit: DC Studio/Shutterstock.com. Arm has introduced Performix, a new performance analysis toolkit designed to help developers optimise AI agent workloads across the company’s compute platform. The launch comes alongside the company’s ongoing shift towards supporting increasingly complex and automated AI systems. Performix is being offered as a free toolkit that integrates with contemporary, automated development workflows. By providing access to system-wide performance metrics, it allows developers and AI agents to identify operational inefficiencies and optimise software running on Arm-based infrastructure. This includes support for both traditional cloud deployments and newer hardware, such as the Arm AGI CPU. Arm AI and developer platforms senior vice president Alex Spinelli said: “The shift to agentic AI is introducing new performance challenges. Workloads are becoming more complex, spanning multiple components and layers, while traditional tooling remains designed for monolithic, manually analsed applications. “At the same time, performance tools must integrate into automated workflows and be usable directly by AI agents, with outputs that are structured, repeatable and actionable.” Performix is intended to provide continuous, expert analysis and actionable insights on key system metrics including memory bandwidth, latency, cache efficiency and CPU utilisation. This approach is intended to move software performance evaluation from a process relying on manual interpretation of low-level hardware data towards automated, repeatable, and structured outputs. The toolkit’s core is the Arm MCP Server, which interfaces directly with development environments and tools including GitHub Copilot, Kiro, Gemini and Codex. This integration allows developers and AI assistants to initiate analysis from within their workflow

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CEOs face congressional hearing on high hospital pricesindustry

CEOs face congressional hearing on high hospital prices

CEOs face congressional hearing on high hospital prices CEOs of four health systems testified before the House Ways and Means Committee on Tuesday morning. Policy and Legislation By Susan Morse , Executive Editor | April 28, 2026 | 11:18 AM From left: Sam N. Hazen, CEO of HCA Healthcare, Wright Lassiter III, president and CEO of  CommonSpirit Health, Brian G. Donley, president and CEO of New York Presbyterian, Dr. Michael Waldrum, CEO of ECU Health and Brad Woodhouse, president of advocacy organization Protect Our Care Photo: Susan Morse screenshot/House Ways and Means Committee The CEOs of four health systems testified before the House Ways and Means Committee Tuesday in a hearing about the high price of healthcare. Sam N. Hazen, CEO of HCA Healthcare, Wright Lassiter III, president and CEO of  CommonSpirit Health, Brian G. Donley, president and CEO of New York Presbyterian, Dr. Michael Waldrum, CEO of ECU Health and Brad Woodhouse, president of advocacy organization Protect Our Care, testified.“Simply put, hospitals are charging an insane amount for care. Hospital prices have skyrocketed 300% in just over two decades – more than any other sector of our economy.,” said Ways and Means Chairman Jason Smith (R-Mo). “Hospital consolidation and mergers, that lead to ever-growing market power, are fueling the borderline extortionary prices hospitals charge patients.” Of 4,500 hundred hospitals, 2,000 have undergone a merger, Smith said. “The result is that today, 90% of hospital beds are part of a health system,” he said. “The pace and scale of mergers have led to market concentration that puts patients at the mercy of hospital empires. When hospitals have no competition, it’s no wonder that the sky seems to be the limit for prices.”Ranking Member Richard Neal (D-MA) countered that the cost of healthcare - in which technology helps to drive cost - is not just about the providers but about legislative policies. “There’s never been a Repu

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ACA market dynamics cost HCA $150M in Q1industry

ACA market dynamics cost HCA $150M in Q1

ACA market dynamics cost HCA $150M in Q1 Underlying shifts in payer mix resulting from the changes in the exchanges were generally in line with expectations, says CEO Sam Hazen. Accounting & Financial Management By Susan Morse , Executive Editor | April 28, 2026 | 11:13 AM Photo: Rusty Russell/Getty Images HCA Healthcare reported a 0.6% net income increase to $1.6 billion during the first quarter and revenue gains of 4.3% to $19.1 billion.One unexpected factor drove down patient volume related to profits.“From a volume perspective, we did not experience the typical lift related to seasonal respiratory conditions,” said Director and CEO Sam Hazen. “Compared to the first quarter of last year, our respiratory-related admissions were down 42%, and our respiratory-related emergency room visits were down 32%.”Additionally, storms impacted some of the for-profit health system’s markets.“The respiratory-related and winter storm impacts were mostly contained to January, with February and March volumes rebounding nicely,” Hazen said.Another issue was a $150 million cost due to the lack of the enhanced subsidies in the Affordable Care Act market.“We estimate the adjusted EBITDA impact from the exchanges to be approximately $150 million in the first quarter of 2026 versus the prior year quarter,” said CFO and Executive Vice President Mike Marks.“Regarding payer mix for the quarter, the underlying shifts resulting from the changes in the health insurance exchanges were generally in line with our expectations,” Hazen said. “This area remains fluid. As we stated in our fourth quarter call, we have considered a range of potential scenarios as the effects continue to evolve.”Marks gave same-facility volume comparisons for the first quarter of 2026 versus the first quarter of 2025.Admissions increased 0.9%, equivalent admissions increased 1.3%, inpatient surgeries were down 0.3% and outpatient surgeries declined 1.7%, Marks said. ER visits increased 0.3%. “As Sam mentioned,

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