Georgia Man Sentenced for $7.2M Medicare Genetic Testing Kickback Scheme
Patrick C. Moore Jr. sentenced to 46 months and $7.2M restitution for Medicare genetic testing kickback fraud. DOJ and HHS-OIG enforcement highlights healthcare fraud risks.
CMS Expands IRF Review Choice Demonstration to Texas and California
CMS extends its Medicare Inpatient Rehabilitation Facility Review Choice Demonstration to include Texas and California IRFs, increasing claims oversight and regulatory compliance requirements.
CMS Proposes Enhanced MA Plan Enrollment Flexibility for Seniors
CMS proposes new measures to allow Medicare Advantage enrollees to switch plans mid-year following provider network changes, improving continuity of care for seniors.
CMS Introduces ACCESS Model to Enhance Technology-Based Chronic Care in Medicare
The CMS ACCESS Model launches in 2026 to pilot outcome-focused payments in Original Medicare, expanding technology-supported chronic care and integrating with primary providers for improved patient outcomes.
Medicare Insurers Strategically Shift Sicker Beneficiaries Through Plan Design
Medicare insurers increasingly adjust plan benefits and formularies to strategically shift sicker beneficiaries, impacting risk pools and competitive dynamics in the Medicare Advantage market.
UNC Health-Cigna Contract Breakdown Disrupts In-Network Coverage for 65,000 Patients
The UNC Health and Cigna contract lapse leaves tens of thousands out-of-network, highlighting ongoing challenges in hospital-insurer negotiations and payer-provider relationships in North Carolina.
CMS Launches ACCESS Model to Advance Technology-Enabled Chronic Care in Medicare
CMS introduces ACCESS model to enhance technology-supported care and outcome-based payments for Medicare patients with chronic conditions starting in 2026.
Maine Faces Surge in Medicare Enrollment Assistance Demand Amid Plan Disruptions
Rising Medicare Advantage plan terminations in Maine drive unprecedented demand for enrollment assistance, highlighting resource constraints amid complex federal and provider changes impacting seniors' health coverage.
OIG Uncovers Major PDPM Billing Noncompliance in Skilled Nursing Audit
The OIG's audit reveals significant noncompliance with PDPM billing in skilled nursing facilities, prompting potential repayments exceeding $31 million and signaling broader risks for Medicare reimbursement compliance.
UNC Health-Cigna Contract Dispute Threatens In-Network Coverage for Thousands
The unresolved contract dispute between UNC Health and Cigna risks out-of-network status for thousands of patients, reflecting broader insurer-provider negotiation challenges in North Carolina's healthcare market.