Survey by Civitas Networks for Health shows Medicare Quality Improvement Organizations generated $4.7B savings and highlights recommendations for program enhancements focusing on data interoperability, onsite training, and workforce retention.

A federal court has blocked key staffing requirements in the 2024 CMS rule for long-term care facilities, creating regulatory uncertainty amid ongoing litigation and legislative attempts to pause implementation until 2034.

Humana Healthy Horizons now offers Medicaid managed care coverage to Virginia Cardinal Care beneficiaries, enhancing integrated health services and behavioral health support.

Wyoming adopts a Medicare birthday rule allowing seniors to switch Medicare Supplement plans annually without denial, boosting competition and affordability in the Medigap market.

CMS launches a six-year pilot requiring pre-authorizations for 17 medical services in traditional Medicare across six states, aiming to control costs and reduce service overuse.

UnitedHealth Group stock falls amid CMS regulatory changes and DOJ probe, presenting high volatility for investors. Insight into earnings impact and market outlook.

Nevada establishes the Nevada Health Authority to consolidate Medicaid, ACA exchange, and public employee benefits for improved purchasing power and coverage options effective July 1.

Astrana Health's Q1 2025 earnings reveal revenue growth offset by margin compression due to Medicaid utilization and integration investments. Key focus on full-risk contracts and regulatory renewals.

Detailed analysis of recent Medicare Advantage enforcement activities focused on broker arrangements, Oak Street settlement, and DOJ False Claims Act litigation impacting healthcare compliance and beneficiary protection.

Michigan physician sentenced to four years for involvement in $6.3 million Medicare fraud, emphasizing the need for robust fraud detection and compliance in healthcare.