CMS Finalizes 2026 Medicare OPPS and ASC Payment Rates with 2.6% Increase
CMS finalizes the 2026 Medicare OPPS and ASC payment rates with a 2.6% increase, including quality reporting penalties and maintained 340B payment adjustments.
Health First Urgent Care Settles $2.8M Medicare Medicaid Overbilling Case
Health First Urgent Care agrees to $2.8 million settlement for Medicare and Medicaid overbilling linked to improper diagnostic test billing practices in Washington State.
Judge Denies Humana's Challenge to CMS 2025 Medicare Advantage Ratings
A U.S. court rejected Humana's attempt to contest the CMS 2025 Medicare Advantage ratings, affecting Humana's bonus payments and highlighting CMS's regulatory role.
Freedom Health Settles Medicare Advantage False Claims for $31.7M
Freedom Health agreed to pay $31.7M to settle allegations of False Claims Act violations relating to Medicare Advantage payment schemes. The settlement underscores regulatory enforcement in managed care and Medicare compliance.
Medicare Advantage Growth Spurs Skilled Nursing Care Delays, Calls for Provider Adaptation
Medicare Advantage expansion is linked to care delays in skilled nursing facilities, urging providers to better understand MA protocols for improved patient outcomes.
Medicare Audits Intensify: Strategic Defense with Statistical and Clinical Expertise
Medicare audits are becoming more frequent and aggressive, leading to inflated repayment demands. Learn how statistical challenges, independent coding reviews, and specialty expertise can protect healthcare providers from exaggerated audit outcomes.
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.