Georgia Man Sentenced for Illegal Medicare Genetic Testing Kickback Scheme
Georgia man sentenced to 46 months and $7.2M restitution for illegal Medicare kickbacks tied to unnecessary genetic tests, reflecting enforcement on healthcare fraud.
Curative Raises $150M to Expand No-Cost Preventive Care Insurance Plans
Curative secures $150 million in Series B funding to grow its no-cost preventive care insurance plans across new U.S. markets, enhancing AI and network capabilities.
Addressing 'Ghost' Networks in Medicare Advantage and Medicaid Managed Care
Explore the challenges of ghost networks in Medicare Advantage and Medicaid managed care, highlighting network adequacy issues, limited CMS enforcement, and upcoming data transparency rules.
Medicare Open Enrollment Deadline Approaches for Nearly 70 Million Beneficiaries
Nearly 70 million Medicare beneficiaries face an upcoming open enrollment deadline, with potential for significant healthcare cost savings by timely plan selection. Resources like Medicare.gov provide essential information.
CMS Proposes Medicare Coverage for CBD Products Under New Regulatory Framework
CMS updates Medicare Advantage policy to allow insurance coverage for federally and state-legal CBD products, amid evolving hemp regulatory definitions and market challenges.
Medicare Fraud Sentencing: $7.2M Restitution and Prison for Peachtree City Man
Patrick Moore Jr. sentenced to 46 months and $7.2M restitution for Medicare fraud involving unnecessary genetic testing and illegal kickbacks.
Medicare Advantage Plan Terminations in Rochester-Finger Lakes Region for 2026
Medicare Advantage plans in Rochester-Finger Lakes are terminating in 2026, requiring beneficiaries to select new plans by Dec 7 or revert to Original Medicare with higher costs. Understand the implications for prescription costs and coverage changes.
CMS WISeR Model Launches AI-Driven Prior Authorization in Medicare
CMS's WISeR Model introduces AI-powered prior authorization for Medicare outpatient procedures, impacting approval times and denials in six states starting 2026.
CMS Proposed 2027 Medicare Advantage and Part D Changes Focus on Simplification and Oversight
CMS releases Proposed 2027 Rules for Medicare Advantage and Part D, emphasizing Star Ratings simplification, marketing oversight updates, expanded risk adjustment data use, and Part D redesign implementation.
Medicare Open Enrollment Deadline Approaches for 70M Beneficiaries
Nearly 70 million Medicare beneficiaries face the approaching open enrollment deadline. Learn how to navigate Medicare.gov for enrollment and potential cost savings.