Senior Market Sales Acquires Giardini Medicare, Boosting Digital Medicare Marketing
Senior Market Sales acquires Michigan-based Giardini Medicare, enhancing digital Medicare education and marketing capabilities through social media.
Hospitals Face Financial Challenges Serving Medicare Inpatient Fee-for-Service Cases
Analysis reveals most hospitals lose money on Medicare inpatient fee-for-service cases, with stronger financial performance in for-profit versus not-for-profit and teaching hospitals due to cost and payment structures.
Financial Pressures Threaten Private Orthopedic Practices and Patient Access
Declining Medicaid and Medicare reimbursements strain private orthopedic practices, limiting patient access and prompting calls for policy reforms to support sustainability and equitable care.
CMS to Test AI-Driven Prior Authorization in Medicare Under WISeR Model
CMS launches WISeR model applying AI-driven prior authorization to Traditional Medicare, targeting fraud and waste with clinician oversight. Providers face operational and financial impacts.
DOJ Investigates UnitedHealth Group Over Medicare Advantage Billing Practices
The DOJ is investigating UnitedHealth Group for Medicare Advantage billing practices amid nationwide scrutiny on upcoding, prompting CMS to increase audits of plans and intensify fraud prevention efforts.
Operation Gold Rush Uncovers $10.6B Medicare Fraud Scheme Leveraging AI for Prevention
Operation Gold Rush exposes a $10.6 billion Medicare fraud scheme involving international crime rings and highlights the shift towards AI-driven proactive fraud prevention and enhanced Medicare data analytics.
UnitedHealth Faces Multiple Shareholder Lawsuits Over Medicare Billing Investigations
UnitedHealth Group faces multiple shareholder derivative lawsuits linked to DOJ investigations of Medicare billing practices, highlighting regulatory and corporate governance issues.
Clover Health Launches Community Pharmacy Pilot in New Jersey
Clover Health partners with IPC Digital Health to launch a community pharmacy pilot in New Jersey, leveraging AI and local pharmacists to improve medication adherence and health outcomes for Medicare Advantage members.
Clover Health Launches AI-Powered Community Pharmacy Pilot in New Jersey
Clover Health partners with IPC Digital Health to launch an AI-driven community pharmacy pilot in New Jersey, enhancing medication adherence and chronic care for Medicare Advantage members.
Advanced Practice Providers Address Physician Shortages and Healthcare Workforce Challenges
Explore how Advanced Practice Providers (APPs) help mitigate physician shortages and support healthcare workforce strategies amid budget constraints. Insights into nurse leadership and healthcare communication.