CMS's 2027 Proposed Rule introduces major Medicare Advantage and Part D program reforms including Star Ratings revisions, risk adjustment data access expansion, marketing rules relaxation, and new special enrollment periods for provider terminations.
CMS requests public comments on 2027 proposed regulatory changes to Medicare Advantage, Part D, and Cost Plan programs to streamline compliance and reduce administrative burdens.
CMS's 2026 Physician Fee Schedule rule expands eligible providers and initiating visits for Community Health Integration services, enhancing behavioral health integration and reimbursement pathways.
Patrick C. Moore Jr. sentenced to nearly four years in federal prison and ordered to pay $7.2 million for orchestrating a Medicare fraud scheme involving unnecessary genetic tests and illegal kickbacks.
Georgia man sentenced to nearly four years in prison and ordered to pay $7.2 million for orchestrating a Medicare fraud scheme involving unnecessary genetic testing and illegal kickbacks.
Explore how IRMAA impacts Medicare premiums for higher-income beneficiaries and its significance for U.S. healthcare insurance and compliance professionals.
HHS-OIG audit uncovers $39.6 million in potentially improper podiatry E/M payments, urging CMS to enhance Medicare oversight in billing practices.
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 $1.9 million Medicare false claims case involving behavioral health psychotherapy billing violations. Impact on compliance and regulatory enforcement.
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.
