Can AI reduce health care fraud, AI firm in Texas AG’s crosshairs, and more

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Texas AG decides to investigate AI health

In other legal matters, the Texas Attorney General has reached a settlement with a Dallas health AI company that the state accused of making false claims about the accuracy and safety of its products before sending them to Texas hospitals. . Company, called Piecessells AI-powered technology it says provides an overview of patient conditions and treatment to nurses. The AG concluded that Pieces’ metrics for accuracy, and its complaints about the relatively low rate of sightings, were themselves inaccurate. Read more.

Can AI reduce theft, waste and abuse?

Education about NEJM Catalyst suggests that using AI to screen medical claims for fraud, waste and abuse can reduce false claims. In a review led by several employees of a health analytics company Health at Scale and a health technology platform Personalize Health and go Massachusetts Institute of Technology and goes University of Michigan, The authors report that the AI ​​analysis identified about $12 million in inappropriate claims before they were paid, about 1.2% of the total use of about 300,000 claims. The technology, marketed by Health at Scale, requested medical records for patients whose claims were flagged to ensure that “to coordinate medical services and measures related to the guidelines and standards of medical care.” Read more.

Novartis is involved in AI drug development with Generate:Biomedicines

Pioneering Flagship‘s Produce: Biomedicineswhich uses AI to develop new medicines, has revealed a partnership with Novartis comes with provisions for different disease areas, Brittany Trang reports. The deal comes with significant payments, giving the company about $1 billion in cash including royalties. Produce receives 65 million dollars from Novartis, including $ 15 million for some equity – undisclosed amount – in the company. Read more about the agreement here.

HHS watchdog examines remote patient monitoring

Virtual care advocates and skeptics have long debated whether telehealth and remote care create new risks of fraud and abuse. Now, it’s new Department of Health and Human Services The watchdog report suggests remote patient monitoring and fees for those services — think devices like digital blood pressure cuffs that doctors can use to monitor patients remotely — are ripe for of abuse, my colleague Katie Palmer reports.

HHS’ Office of the Inspector GeneralThe report calls for more attention to remote patient monitoring with devices such as connected scales and continuous glucose monitors, at least within Medicare. The report is also full of data on the use of RPM: The number of Medicare patients receiving remote patient monitoring services has increased from 55,000 to 570,000 between 2019 and 2022; Medicare benefits patients increased 14 times during that period. Total Medicare spending on RPM services has increased to $311 million by 2022.

Where can the abuse be? Providers can even overuse these tools and services and drive up costs, the analysis suggests.

“Provider recommendations are sometimes inconsistent with the true value to patients and society at large,” Harvard Business School medical student Mitchell Tangwho studied RPM at Medicare, told Katie. Read more about the OIG’s findings.

New bill on telehealth prescription of stimulants

Also in terms of virtual care, some members of Congress are running to ensure that the ability of nurses to provide controlled devices via telehealth is not obsolete: My colleagues Lev Facher and Mario Aguilar report on especially the new bill written by longtime advocates Sen. Mark Warner (D-Va.) and Rep. Doris Matsui(D-Calif.) to extend the pandemic status until 2026. That bill is being written as Center for Drug Enforcement puts together new rules that can reverse those conditions. “I am very concerned about the future of the changing landscape for health services regarding the teleprescription of controlled substances,” Warner said in a statement to STAT. Read more at Lev & Mario.

Past challenges of the FDA protection industry

My colleague Lizzy Lawrence has a unique report about Food and Drug Administrationchoice to lead its medical device safety office: Ross Segan it was who was formerly the chief medical officer at endoscope company Olympuswhich it itself accepted FDA warning letters stating that they do not address product defects (including, most disturbingly, caps that fell off patients’ bodies.)

“Olympus’ continued failure to meet FDA requirements demonstrates a complete disregard for patient safety,” Jeffrey Shurenhead of the FDA’s medical device agency, he said at the time. Segan takes over William Maiselwho came down as director of assessment and quality at Center for Radiological Resources and Health in February after 14 years at the FDA. Read more about Lizzy.

Particle Health is suing Epic over privacy practices

The medical records giant Epic Systems’ market dominance has long been an open secret within the world of health technology. But now a small health news publication is taking the unusual step of suing Epic, accusing it of private practices and using its power to undermine the competition.

In a federal lawsuit filed this week in the Southern District of New York, Part Health called Epic a “Behemoth” and “monopolist in the EHR software market,” Casey Ross reports. Epic, for its part, called the allegations “baseless” and accused Particle of disclosing patient information on the health information exchange, which led to a dispute between Particle and Epic earlier this year. Read more about Casey’s suit, and submit your comments and stories.

What we read

  • Amazon cuts ties with fertility company, STAT
  • Q&A with Bristol Myers Squibb’s chief digital and technology officer, Endpoints
  • Ginkgo Bioworks is betting on an AI protein model to turn around a struggling company, STAT


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