CMS proposes to revamp Medicare Advantage Star Ratings, affecting insurer compliance and operations. Legal appeals and health system updates also impact the US market.

KFF research reveals widespread use of chart reviews in Medicare Advantage, increasing diagnoses and boosting CMS payments with AI-driven risk adjustment implications.

SCAN Health Plan strategic response to Medicare patient challenges highlights healthcare system inefficiencies and innovation in Medicare managed care.

Medicare 2026 premiums surge nearly 10%, with fewer Medicare Advantage plans as insurers scale back. Explore key Medicare cost drivers and market impacts.

Health First Urgent Care agrees to $2.8 million settlement for Medicare and Medicaid overbilling linked to improper diagnostic test billing practices in Washington State.

CMS unveils the GENERous Medicaid payment model introducing MFN drug pricing, alongside expanded Trump administration drug pricing agreements and key regulatory updates for 2026.

The CMS-funded GUIDE Program enhances dementia care with coordinated, personalized support for Medicare beneficiaries and caregivers in community settings.

The U.S. government passed H.R. 5371, ending the shutdown and extending Medicare telehealth flexibilities through January 2026, ensuring continued coverage and retroactive payments for telehealth claims.

CMS introduces the Ambulatory Specialty Model, a new mandatory payment model for specialists treating low back pain and heart failure, effective from 2027 to improve care quality and reduce costs.

Examining Aetna's new inpatient payment policy for Medicare Advantage plans, its conflicts with Medicare's Two-Midnight Rule, and implications for hospital reimbursement and compliance.