INSURASALES

Michigan Health Market Review 2024 Highlights Medicaid Enrollment Decline and Hospital System Consolidation

The 2024 Michigan Health Market Review details Medicaid enrollment declines, growth in Medicare Advantage and individual plans, and hospital system consolidation impacting payer and provider finances.

Senators Propose Bill to Tighten Medicare Advantage Risk Adjustment, Curb Overpayments

Senators introduce bipartisan bill targeting Medicare Advantage overpayments by refining risk adjustment and supporting CMS audits to enhance program integrity and save Medicare billions.

Anthem Blue Cross and OhioHealth Secure Multi-Year Network Agreement in Ohio

Anthem Blue Cross and Blue Shield in Ohio and OhioHealth finalize a multi-year network participation agreement ensuring uninterrupted access for members across all plan types, emphasizing value-based care metrics.

Medicare 2025 Trustees Report: Financial Outlook and Cost Drivers

A detailed analysis of the 2025 Medicare Trustees Report outlines financial projections and key cost drivers including Medicare Advantage's impact and reimbursement challenges.

HCA Florida Kendall Hospital Debuts Robot-Assisted Spinal Fusion Surgery

HCA Florida Kendall Hospital in Miami performed its first robot-assisted transforaminal lumbar interbody fusion led by neurosurgeon Michael Fromke, utilizing new robotic technology to enhance spinal surgery precision and outcomes.

Medicare Sequestration Cuts Triggered by 2026 Due to New Tax Bill

The recent Republican tax legislation will trigger automatic Medicare payment cuts starting in 2026 due to sequestration mandated by the Budget Control Act, impacting provider reimbursements through 2034.

Rhode Island AG Updates Medicare Advantage Info Amid Network Changes

Rhode Island Attorney General updates consumer resources on UnitedHealthcare Medicare Advantage plan changes due to Brown University Health network removal and CMS special election period.

Rural Health Fund Faces Distribution Challenges Amid Hospital Classification Issues

States to apply September for $50B Rural Health Fund amid Medicare cuts; concerns over urban hospitals dual-classified as rural impacting fund allocation.

CMS Price-Substitution Policy Saves $76M on Medicare Drugs Since 2013

CMS's price-substitution policy has saved $76 million for Medicare by correcting drug pricing identified by the Office of Inspector General, improving cost efficiency while maintaining access.

Massachusetts Man Pleads Guilty in $4M Medicare DME Fraud Scheme

Krishna Gidwani pleaded guilty to conspiracy in a $4M Medicare fraud involving durable medical equipment. Part of DOJ's 2025 National Health Care Fraud Takedown.