OIG Highlights Medicare RPM Billing Risks in 2025 Report
The August 2025 OIG report analyzes Medicare billing for remote patient monitoring services, highlighting fraud risks and compliance recommendations amid rising RPM usage.
Elevance and Major Insurers Adjust Medicare Advantage Strategies Amid Cost Pressures
Elevance Health and leading insurers recalibrate Medicare Advantage plans and Part D coverage amid rising costs and regulatory shifts, focusing on risk management and compliance.
DOJ Expands Probe into UnitedHealth's Prescription Services and Physician Payments
The DOJ is broadening its investigation of UnitedHealth Group, examining prescription management practices at Optum Rx and physician reimbursement methods amid concerns beyond Medicare fraud.
2025 J.D. Power Medicare Advantage Study Highlights Member Onboarding Opportunities
The 2025 J.D. Power Medicare Advantage Study identifies declining member satisfaction and highlights how digital onboarding and transparency improve member trust across U.S. Medicare Advantage plans.
CMS Extends Medicare Revalidation Deadline for Skilled Nursing Facilities to 2026
CMS extends the Medicare off-cycle revalidation deadline for skilled nursing facilities to January 1, 2026, maintaining the existing requirements. Providers should prepare to comply to avoid Medicare participation disruptions.
US Files Civil Forfeiture Suits Over $33M Medicare Fraud by DME Providers
US government pursues civil forfeiture against two Florida DME companies accused of over $33 million in fraudulent Medicare claims for medically unnecessary equipment and services.
CMS Proposes Major 2026 Medicare Rule Changes Affecting Inpatient Care and Outpatient Surgery
CMS 2026 outpatient rule proposes major changes including inpatient-only list elimination and expanded ambulatory surgery center procedures, impacting Medicare payment and compliance.
Aetna Updates Medicare Advantage Inpatient Reimbursement Policy Effective Nov 15
Aetna implements a new inpatient reimbursement policy for Medicare Advantage plans to streamline payments and align with CMS two-midnight rule, effective Nov 15, 2023.
Virginia Foxx's Legislative Impact on Healthcare and Insurance Regulation
Analysis of Virginia Foxx's legislative positions affecting healthcare, insurance regulation, and employer health data management, with insights into compliance and market implications.
Key Medicare Part A Criteria for Skilled Nursing Facility Coverage Explained
Understand the Medicare Part A requirements for skilled nursing facility coverage, including qualifying hospital stays, coverage limits, and copay costs essential for healthcare professionals and insurers.