Healthcare Central

  • AI is shaping medical coverage decisions. Here’s how to tell the story

    Whether a health insurer denies or approves a medical procedure, there’s a good chance AI was involved in the review. Increasingly, insurers are using artificial intelligence for prior authorization, concurrent review and retrospective and utilization review — terms MedCity News recently defined in an overview of utilization review.  “AI is in all of them,” said…

  • Reports show Medicare insurers boosted income in questionable ways

    In 2024, the Office of Inspector General (OIG) found that health insurers added new — and questionable — diagnoses to 1.7 million Medicare Advantage (MA) members, generating approximately $7.5 billion in higher payments for those insurers. For journalists, payments that raise questions from regulators translate into a major story because they can harm patients and…

  • Are bigger hospitals and insurers better for consumers?

    UnitedHealthcare corporate headquarters in Minnetonka, Minn. in 2024. Photo by Chad Davis (CC BY 2.0) Over the past 30 years, consolidation of health care systems in the United States has accelerated through mergers and acquisitions, researchers reported last year in the Journal of the American College of Surgeons. After reviewing 34 years worth of studies…

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