Arizona’s AHCCCS reported a 92% collapse in suspect behavioral health billing after suspending hundreds of providers in the American Indian Health Program sober-living scheme. Operators in 1115-waiver states should harden patient-brokering controls, credentialing files, and ASAM documentation now, before enforcement spreads.
On May 15, 2025, the DOL, HHS, and Treasury announced they will not enforce the 2024 MHPAEA Final Rule. Brandi Cameron breaks down what the non-enforcement posture means for NQTL complaints, SCA pricing, denial appeals, and rate negotiations at Florida, Pennsylvania, and Tennessee facilities.
Atar Capital’s exit from Clarvida, a 17-state Medicaid-reliant outpatient and telehealth platform, is the clearest read yet on what PE buyers will pay for in the Medicaid BH segment. Here is what diligence will actually look like, and what sellers must prepare to defend.
Private equity in behavioral health is no longer flying under the radar. The DOJ, FTC, HHS-OIG, and state AGs in California, Massachusetts, and New York are reshaping what diligence, governance, and operations have to look like post-close.
Massachusetts MassHealth’s retroactive recoupment against ABA providers is not an isolated event. It is a preview of how states will use post-payment review as a budget lever. Here is what behavioral health operators need to lock down now, and how AHS helps multi-state platforms respond.
Nebraska’s Medicaid work requirement took effect May 1, 2026. For SUD and MH operators, this is a census event, a payer-mix event, and a documentation event. Here is what to model, what to write into intake workflows, and how to protect patients mid-treatment.
Laurel Ridge Treatment Center’s CMS provider agreement termination and the resulting 648 layoffs is the clearest warning shot behavioral health has had in years. Here is what likely drove it, and how operators build the compliance infrastructure to never be next.
Utah’s regulatory mitigation agreement with Legion Health is the first real template for how state agencies will license and supervise AI-driven psychiatric workflows. AHS unpacks what the guardrails likely look like and what operators in Florida, New York, and Pennsylvania should expect next.
Substance use disorder is a chronic condition, but most programs are still built around episodic admissions. Here is how operators and PE-backed buyers should rethink feasibility, pro formas, and licensure to build continuums that payers actually want to contract with.
DOJ’s newly resourced National Fraud Enforcement Division puts behavioral health operators back in the crosshairs. Sariah Hopkins translates the announcement into concrete actions for CEOs and compliance leads: medical necessity tightening, UR rebuilds, billing audits, and pre-close diligence that holds up under federal scrutiny.
