CareTalk: Healthcare. Unfiltered.
Aug 5, 2026 · 3 min · 1 segments
Send us Fan Mail Medicaid and Medicare used to pay first and chase fraud later. That model is changing fast, and the providers who haven't adapted…
John DriscollHost
David WilliamsHost

As we're going through restructuring, health plans coming in and out of the Medicare managed care program because of V28 and covering different geographies with different kind of benefits.

And in Medicaid, a lot of people, you know, falling off of coverage and falling off of the exchange.

What's going on in your practices? What are you seeing happening to vulnerable populations right now? John,

I think right now it's probably the most, I would say, turbulent times for these populations.

One is we're seeing, you know, Vice President announced a $1.3 billion suspension of Medicaid payments in California.

We're seeing fees for Medicare enrollments for new home healthcare and hospice providers across the country, right? There's a lot of focus from Dr.

And I'm not getting in this show and whether it's right or wrong, that's besides the point, but we're just seeing a lot of focus on that area.

We're now seeing AI getting deployed to basically understand, moving from what they call, hey, we used to pay and then we chase you, to now we're auditing first and then paying later.


And remember, these are organizations that already have very thin margins, right? So we're seeing a huge shift.

Their mindset is, if I don't change now, if I don't rethink my workflows and how I operate, it just won't be sustainable.
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