CMS Administrator Dr. Mehmet Oz prioritizes eliminating $100B waste, fraud, and abuse in Medicare and Medicaid to protect federal health spending and vulnerable beneficiaries.

Genexe, LLC and others pay $6 million to resolve allegations of Medicare fraud involving medically unnecessary genetic tests and kickbacks. Enforcement in healthcare compliance continues.

CMS fines three PACE organizations totaling $142,788 for failure to meet essential service and documentation requirements, highlighting compliance challenges in managed care programs.

Explore the 2024 CMS prior authorization rule and the impact of AI on healthcare administrative processes, improving compliance and patient care timelines.

Vault Medical Services agrees to pay $8 million to settle false claims related to Covid-19 testing reimbursements under the federal Uninsured Program, highlighting compliance challenges in pandemic healthcare billing.

Genexe and Immerge settle $6M case resolving false Medicare claims for unnecessary genetic tests involving kickbacks. Settlement addresses healthcare fraud and whistleblower suits under the False Claims Act.

Maryland's Department of Health struggles with psychiatric bed shortages, leading to legal challenges and increased judicial fines amid mounting patient backlogs.

CMS finalizes key aspects of the 2026 Medicare Advantage and Part D programs rule, including expanded insulin coverage, payment plans, and new pharmacy requirements for network participation.

Medicare's ongoing pay cuts strain primary care physicians, intensifying doctor shortages and risking access to care for the growing senior population. Increased audits and complex billing compound challenges, pushing some doctors out of Medicare.

Explore how the 2024 Medicare Advantage Final Rule impacts hospitals and the strategic adjustments necessary for compliance. Learn about the importance of the Two-Midnight Rule, enhanced provider-payer collaborations, and the role of technology in optimizing healthcare outcomes.