The 2025 decline in Medicare Advantage Star Ratings intensifies regulatory scrutiny. Black Book Research reveals health IT strategies top plans use to boost quality, member experience, and compliance across all payers.
The DOJ has filed a False Claims Act complaint against GoHealth, alleging illegal kickbacks to brokers for Medicare Advantage enrollments, triggering a securities investigation and stock decline.
Fernando Valenzuela Ayub pleaded guilty to a $51 million Medicare fraud scheme involving durable medical equipment. The case highlights key issues in Medicare billing and compliance.
CMS revises Kidney Care Choices Model with new financial methods and incentives to balance rising costs and quality improvements, extending program through 2027.
Explore how rising diabetes-driven kidney failure is escalating Medicare costs and straining transplant resources, highlighting the need for early intervention and Medicaid's critical role.
CMS ramps up oversight to stop misuse of Medicaid funds for noncitizen coverage, enforcing federal eligibility rules and recouping improper spending.
The pending domestic policy bill proposes significant Medicare payment cuts, expanded HSA contributions post-Medicare enrollment, rural hospital classifications, and tightened eligibility rules, impacting coverage and payment structures.
Analysis of federal drug price negotiations under the Inflation Reduction Act, examining perverse incentives in Medicare and private insurance, and exploring Medicare Advantage reforms to improve market efficiency and patient coverage.
UnitedHealth faces DOJ investigation and Medicare scrutiny amid rising medical costs, yet diversification through Optum supports potential recovery in 2025.
UnitedHealth Group faces federal investigations over Medicare Advantage practices amid rising scrutiny of private Medicare plans. Explore the implications for insurance regulation and healthcare market dynamics.
