Operation Gold Rush exposes a $10.6 billion Medicare fraud scheme involving international crime rings and highlights the shift towards AI-driven proactive fraud prevention and enhanced Medicare data analytics.
UnitedHealth Group faces multiple shareholder derivative lawsuits linked to DOJ investigations of Medicare billing practices, highlighting regulatory and corporate governance issues.
Clover Health partners with IPC Digital Health to launch a community pharmacy pilot in New Jersey, leveraging AI and local pharmacists to improve medication adherence and health outcomes for Medicare Advantage members.
Clover Health partners with IPC Digital Health to launch an AI-driven community pharmacy pilot in New Jersey, enhancing medication adherence and chronic care for Medicare Advantage members.
Explore how Advanced Practice Providers (APPs) help mitigate physician shortages and support healthcare workforce strategies amid budget constraints. Insights into nurse leadership and healthcare communication.
UnitedHealth Group emphasizes strict regulatory compliance and audit accuracy in Medicare Advantage operations following scrutiny by The Wall Street Journal. CMS audits confirm coding integrity and adherence to federal guidelines.
Applied Policy names Brittany La Couture as VP of Health Policy, leveraging her Medicare Advantage and CMS expertise to enhance pharmaceutical reimbursement strategies.
Explore critical Medicare enrollment deadlines, coverage coordination with FEHB, and plan options for federal retirees to optimize benefits and manage costs.
Villages Health System files Chapter 11 bankruptcy following a $350 million Medicare overbilling investigation amid increased Medicare Advantage audits and tighter regulatory scrutiny.
Explore the implications of enrolling in Medicare Advantage plans and later switching to original Medicare with Medigap, focusing on medical underwriting and enrollment restrictions that impact U.S. beneficiaries.
