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Should Current Procedural Terminology (CPT) codes be free for all patients and clinicians to use? That's the question being asked in a recent lawsuit against the American Medical Association (AMA), which holds the copyright to the billing codes. PatientRightsAdvocate.org sued the physicians group in federal court earlier this month, claiming that the AMA in fact "has no valid copyright in CPT" and "has no right to withhold CPT from the public and charge hefty fees for access." (Frieden, 8/26)

Monogram Health has agreed to pay $2.4 million to settle allegations that it submitted unsupported diagnosis codes and overcharged Medicare through the privatized Medicare Advantage program, the Justice Department said Monday. The Tennessee-based home care company allegedly submitted inaccurate or medically unsupported diagnosis codes to insurers from 2021 through 2023, causing the CMS to pay Medicare Advantage plans more, according to the DOJ. (Mukherjee, 8/26)

Radiology Partners, HaloMD and TeamHealth were behind more than three-quarters of No Surprises Act billing cases last year, according a Georgetown University study. Radiology Partners, TeamHealth, SCP Health and AGS Health had win rates exceeding 90%, according to the paper published in the journal Health Affairs Forefront on Wednesday. After the No Surprises Act’s Independent Dispute Resolution process debuted in 2022, the arbitration system quickly became swamped with cases and a slew of third-party vendors began working with both sides to argue over out-of-network claims. (Tong, 8/26)

Every year Jim Evans faces the challenge of keeping health care costs reasonable for the more than 400 teachers, custodians and bus drivers at Concord Community Schools. Evans, the chief financial officer for the Northern Indiana school district is trying something new this year — negotiating directly with a local hospital. "We think that it could be significant savings," said Evans. (Olgin, 8/26)

Healthcare spending isn’t just skyrocketing for U.S. companies. It’s also getting more difficult to predict, complicating efforts to keep cost growth in hand, according to new research. Employers are projecting a median 9.2% increase in health costs in 2027, as hospital prices rise, drugs get more expensive and workers and their families simply get sicker, the Business Group on Health, a nonprofit that represents employers on health benefits issues, found in its latest survey. (Parduhn, 8/26)

Private equity-backed healthcare transactions have slowed as states increase merger and acquisition oversight. Dealmaking in physician practice management, the healthcare sector that typically attracts the most private equity investment, is on pace to decrease 46% this year compared with 2025, according to a recent report from financial data and research company Pitchbook. The slowdown is in part linked to states that have passed laws requiring private equity firms to notify regulators of their proposed transactions or have banned certain types of deals commonly used by corporate investors. (Kacik, 8/26)

Dr. Peter Pisters, University of Texas MD Anderson Cancer Center president, plans to retire at the end of September, the organization announced Wednesday. The University of Texas System board named Dr. Jeffrey Lee, chief physician executive and chief cancer network officer at the cancer center, as interim president, according to a news release. Lee will lead it over the next several years, the release said. (Kacik, 8/26)

The National Committee for Quality Assurance is partnering with artificial intelligence company Komodo Health to test new quality measures. The multiyear strategic partnership aims to use Komodo’s tech to aid NCQA in its development of Healthcare Effectiveness Data and Information Set measures, which include data on preventive care, treatment and patient experience, according to a Wednesday news release. The Centers for Medicare and Medicaid Services and the NCQA use these measures when calculating five-star ratings for Medicare, Medicaid and commercial insurers. (DeSilva, 8/26)

Artificial intelligence documentation startup Suki has launched a dictation tool that transcribes speech into text word-for-word, the company announced Tuesday. The company’s flagship product is a scribe that listens passively in doctors’ offices and turns patient-provider conversations into summarized clinical notes, rather than a transcript. But the new tool captures spoken word verbatim, which can be useful for providers working with complicated medical jargon, Suki said in a press release. (Hughes, 8/26)