Congressional outreach on H-1B physician fee exemption
The AMA is working with Congress and the Administration to secure an exemption for physicians from the new $100,000 H-1B visa application fee. Physicians on H-1B visas play a vital role in providing care to patients in rural and underserved areas, and this new fee could significantly worsen existing workforce shortages.
AMA advocacy staff continue to engage with policymakers to encourage clarifying guidance from the Department of Homeland Security that would exempt physicians and other health professionals. The AMA remains hopeful these efforts will help ensure continued access to care for patients and communities across the nation.
If you want to contact your member of Congress, visit the Physicians Grassroots Network.
CMMI answers your questions on the Wasteful and Inappropriate Service Reduction (WISeR) model
Join leaders from the Center for Medicare and Medicaid Services’ (CMS) Center for Medicare & Medicaid Innovation (CMMI) on Oct. 22 at 8 p.m. ET/7 p.m. CT for a webinar that provides details about the Wasteful and Inappropriate Service Reduction (WISeR) model, which will introduce new prior authorization processes in the Medicare fee-for-service program beginning on Jan. 1, 2026. Register for the webinar. The WISeR model is being piloted initially in six states (New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington) and will include service categories such as skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for knee osteoarthritis. The model will use advanced technologies such as artificial intelligence to support an efficient prior authorization process and is intended to curb waste, fraud and abuse.
The webinar will discuss feedback from AMA to CMMI on WISeR model policies, additional operational details, implications for impacted providers and patients, and there will be an opportunity to raise questions to CMMI leadership. You will be able to submit questions during registration and during the webinar to be answered directly by CMMI.
Introduction
John Whyte, MD, MPH—CEO and Executive Vice President, American Medical Association
Speaker
Abe Sutton—Director of the Center for Medicare and Medicaid Innovation (CMMI) and Deputy Administrator for the Centers for Medicare and Medicare Services (CMS)
AMA seeks to end prior authorization delays in postoperative pain management
The AMA is urging CMS and the Department of Labor to prohibit Medicare Advantage, standalone Medicare Part D, and ERISA plans from imposing prior authorization requirements on prescriptions for up to a 7-day supply of opioid analgesics following surgery and/or hospital discharge. In letters to officials at the Medicare Drug Benefit Group (PDF) and Employee Benefits Security Administration (PDF), the AMA stated that after discharge from hospitals and ambulatory surgery centers, patients with pain deserve timely access to prescribed pain medications, including opioid analgesics. When health plans require prior authorization, there is often little time to obtain the authorization before the last dose of medication given predischarge has worn off. This can lead to unnecessary escalation in patient pain and suffering and, in some circumstances, may lead to emergency visits or readmissions for pain control.
The letters also noted that many health plan restrictions on prescriptions for opioid analgesics arose from 2016 guidelines issued by the Centers for Disease Control and Prevention (CDC). When CDC issued a revised guideline in 2022, the agency explicitly stated that the guidelines are not intended to be implemented as absolute limits for policy or practice across populations. Unfortunately, many health plan limits on prescribing and dispensing of opioids based on the previous 2016 CDC guideline, including use of prior authorization, have never been removed. The AMA advocates that Medicare and ERISA plans be required to remove these restrictions on opioid prescriptions for patients following surgery or hospital discharge.
DEA warns physicians of targeted fraud schemes
The Drug Enforcement Administration (DEA) is warning physicians and other clinicians that they are increasingly being targeted by scams that seek to gain access to medical records or personal information or to generate fake electronic prescriptions.
Fraudsters are impersonating DEA Agents and telling physicians that they are under investigation to gain access to their sensitive information and records. A DEA alert (PDF) reports that both DEA-registrant and non-registrant physicians have been contacted by scammers via letters and telephone calls in this scheme, but it is not DEA’s practice to call physicians regarding investigative matters or to request personal or sensitive information. Fraud incidents can be reported to the Federal Bureau of Investigation or the Federal Trade Commission.
DEA also warns of illegal schemes to generate fake e-prescriptions for controlled substances by exploiting vulnerabilities in e-script software. Scammers are filling thousands of fake e-prescriptions at pharmacies across the country, using clinicians’ identities and credentials without their knowledge. If you suspect you have been the victim of this type of scheme, immediately notify the DEA.
