A recent case of Medicare billing fraud involving a Florida supplier reveals vulnerabilities in claim processing and CMS enforcement measures to combat provider fraud.

The Ninth Circuit confirms broad ERISA preemption of out-of-network provider claims related to pre-service authorizations, reinforcing the scope of federal remedial schemes in insurance disputes.

The Joint Economic Committee critiques COVID-era enhanced premium tax credits for driving up healthcare costs without improving health outcomes, urging a reevaluation of subsidy policies to promote cost reduction and healthier populations.

Zing Health sues HHS and CMS over improper Medicare Part D termination and star rating methodology disputes, claiming significant financial and reputational damages.

Explore the Health Information Privacy Reform Act, a proposed federal bill aimed at broadening health data protections beyond HIPAA, addressing regulatory fragmentation and enhancing compliance in the U.S. healthcare and insurance sectors.

Discover critical factors driving retirees to reconsider Medicare Advantage plans in 2025, including network constraints, pre-authorization challenges, and coverage gaps compared to traditional Medicare and Medigap options.

Geisinger Health System hosts Medicare Advantage plan sessions to guide seniors before the Dec. 7 enrollment deadline. Geisinger Gold earns high CMS ratings with extensive network and member benefits.

Curative Health Insurance secures $150M Series B funding, elevating valuation to $1.25B to expand nationally and enhance AI-powered member services focused on preventative care and regulatory compliance.

GAO report reveals extensive fraud and subsidy misuse in ACA exchanges, highlighting federal oversight failures and risks to taxpayer funds.

GAO uncovers significant fraud vulnerabilities in ACA health insurance exchanges, highlighting unverified subsidies and systemic compliance gaps risking billions in taxpayer funds.