A New York doctor received a seven-year prison sentence and over $2.2 million restitution for a $24 million Medicare fraud scheme involving kickbacks for unnecessary lab tests and orthotic braces. The case highlights federal enforcement efforts against healthcare fraud.
Analysis reveals higher administrative and financial burdens for Medicare Advantage enrollees with multiple chronic conditions, highlighting the impact of managed care on treatment complexity.
CMS proposes removing creditable coverage reporting requirements for HRAs under Medicare Part D to reduce administrative burdens and beneficiary confusion.
Medicare telehealth flexibilities are extended through January 2026, maintaining access for rural and elderly patients. Medicare also launches an AI pilot for prior authorization to streamline outpatient service approvals.
Over 100 healthcare provider groups oppose HHS's proposed HIPAA cybersecurity update amid financial and timing concerns. Sector faces changes in Medicare Advantage, 340B, and insurance market consolidation.
Nassau University Medical Center serves the highest percentage of Medicaid patients on Long Island, facing financial challenges due to low public insurance reimbursements and a high volume of psychiatric and emergency care cases.
The Medicare Diabetes Prevention Program has enrolled less than 1% of eligible beneficiaries since 2018 due to administrative, referral, and awareness challenges despite proven effectiveness. CMS changes aim to improve access and provider reimbursement.
Medicare's outdated reimbursement system is jeopardizing rural office-based medical practices by underpaying for advanced outpatient procedures, leading to consolidation and increased healthcare costs. Proposed reforms aim to preserve independent care and improve access.
CMS introduces the ACCESS Model to enhance chronic care for Medicare beneficiaries using digital health tools and outcome-based payment models starting in 2026.
CMS’s 2026 OPPS final rule updates outpatient payment policies, adjusts 340B drug recoupment, extends site-neutral payment models, expands ASC services, and enhances hospital price transparency requirements effective January 2026.
