CMS reinstates bonus payments for Medicare Advantage plans and proposes removing administrative star rating measures, impacting key insurers like Humana and UnitedHealth Group.
Legal investigation examines CVS/Aetna's use of AI in denying prior authorizations for post-acute care under Medicare Advantage plans, highlighting regulatory and compliance challenges in insurance claims processing.
A former Michigan pharmacist sentenced to prison for submitting fraudulent Medicare claims totaling $4 million for prescription medications never dispensed, highlighting ongoing challenges in Medicare fraud enforcement.
Pharmaceutical companies agree to significant Medicare drug price cuts under Trump administration, projecting billions in savings with impacts on Medicare Part D and drug affordability.
Rising cost pressures and demographic shifts fuel intensified disputes between payers and providers over Medicare Advantage contracts, impacting reimbursement and network participation.
Starting in 2026, MultiCare will no longer accept certain Medicare Advantage PPO plans, impacting access for some seniors. The shift focuses on HMO plans for better care coordination during Medicare open enrollment.
Texas HHSC to transition from Dual Demonstration Program to Integrated Dual-Eligible Special Needs Plan (D-SNP) model in 2026, enhancing Medicare and Medicaid integration for dual eligibles in STAR+PLUS.
Geisinger Health Plan earns 2026 Best Insurance Company for Medicare Advantage in Pennsylvania, recognized for high-quality coverage and member services based on CMS quality measures.
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.
