CMS Narrows Medicare Custody Definition to Expand Coverage Access in 2025
CMS finalized a 2024 rule narrowing Medicare custody to physical confinement, expanding Medicare coverage for community-supervised individuals starting 2025.
Medicare Advantage Plans: Key Drawbacks Affecting Coverage and Care
Explore the critical limitations of Medicare Advantage plans impacting provider access, prior authorization delays, and coverage costs, with insights relevant for healthcare and insurance professionals.
CMS Proposes 2.4% Medicare Payment Increase and New Two-Tier Physician Reimbursement Model for 2026
CMS proposes 2.4% Medicare payment increase for outpatient and surgery centers in 2026 with a new two-tier physician payment model to promote value-based care participation, amid concerns over long-term financial sustainability for providers.
Avoiding Lifetime Penalties in Medicare Part D Enrollment
Learn how to avoid lifetime Medicare Part D penalties by timely enrollment, understanding creditable coverage, and utilizing Extra Help financial assistance programs.
UnitedHealth Medicare Advantage Faces Lawsuits over AI Claims Denials
UnitedHealth Group faces lawsuits and federal probes over AI-driven claims denials in Medicare Advantage, highlighting regulatory risks and the need for ethical plan advisory.
DOJ-HHS Relaunches False Claims Act Working Group to Intensify Healthcare Fraud Enforcement
The DOJ and HHS have reestablished the False Claims Act Working Group to heighten enforcement of healthcare fraud, focusing on Medicare, Medicaid, pricing, and EHR compliance risks.
America's Physician Groups Advocate Accountable Care Relationships for Medicare Beneficiaries
Susan Dentzer of America's Physician Groups emphasizes accountable care relationships for Medicare beneficiaries to improve coordination, reduce hospitalizations, and support smaller practices.
Humana’s Medicare Advantage Legal Setback Highlights Shifting CMS Regulatory Landscape
Humana's legal loss against CMS over Medicare Advantage star ratings underscores structural regulatory risks reshaping insurer margins and strategies in the U.S. Medicare Advantage market.
Judge Dismisses Humana's Medicare Advantage Star Rating Lawsuit Pending Appeals
Humana's lawsuit challenging its Medicare Advantage star ratings was dismissed due to incomplete administrative appeals. The insurer faces a major downgrade impacting 2026 earnings and plans further legal action.
Elevance Lowers 2024 Guidance Amid Rising Medical Utilization and Regulatory Headwinds
Elevance Health lowers 2024 earnings guidance due to rising medical utilization, Medicaid eligibility checks resuming, and regulatory challenges impacting Medicaid and ACA programs.