HHS-OIG Flags $39.6M in Podiatry E/M Billing for CMS Oversight
HHS-OIG audit uncovers $39.6 million in potentially improper podiatry E/M payments, urging CMS to enhance Medicare oversight in billing practices.
CMS Launches ACCESS Model to Transform Chronic Care with Outcomes-Based Payments
CMS announces the ACCESS Model, a 10-year initiative starting in 2026 to advance technology-supported, outcomes-based care for Medicare beneficiaries with chronic conditions, emphasizing performance-driven payments and regulatory compliance.
Mindpath Care Centers Settles $1.9M Medicare False Claims Allegation
Mindpath Care Centers settles $1.9 million Medicare false claims case involving behavioral health psychotherapy billing violations. Impact on compliance and regulatory enforcement.
CMS Proposes Major 2027 Medicare Advantage and Part D Program Reforms
CMS proposes extensive changes to the 2027 Medicare Advantage and Part D programs, including benefit design reforms, new enrollment rules, marketing policy updates, and modifications to quality ratings and special needs plans.
Mindpath Care Centers Settles $1.9M Medicare False Claims Allegations
Mindpath Care Centers agrees to a $1.9 million settlement over false Medicare psychotherapy claims, highlighting ongoing Medicare billing compliance enforcement.
Medicare Hospital Star Ratings Show Challenges for Quad Cities Providers
Medicare star ratings reveal performance challenges for Quad Cities hospitals, with low sepsis care scores and high ER wait times prompting quality improvement initiatives.
Medicare Diagnostic Lab Fraud Nets Two-Year Sentence and $1.17M Restitution
Mohammed Asif sentenced to two years for orchestrating over $1.17 million Medicare fraud through a Washington-based diagnostic lab, highlighting enforcement of healthcare billing compliance.
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.
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.