The DOJ and HHS have reestablished the False Claims Act Working Group to heighten enforcement of healthcare fraud, focusing on Medicare, Medicaid, pricing, and EHR compliance risks.
Humana's legal loss against CMS over Medicare Advantage star ratings underscores structural regulatory risks reshaping insurer margins and strategies in the U.S. Medicare Advantage market.
Humana's lawsuit challenging its Medicare Advantage star ratings was dismissed due to incomplete administrative appeals. The insurer faces a major downgrade impacting 2026 earnings and plans further legal action.
Elevance Health lowers 2024 earnings guidance due to rising medical utilization, Medicaid eligibility checks resuming, and regulatory challenges impacting Medicaid and ACA programs.
Elevance Health lowers its 2025 profit outlook due to higher ACA and Medicaid costs driven by sicker patients and increased care utilization, reflecting an industry-wide trend. Analysts anticipate persistent insurer losses before improvement in 2026.
Understand how Original Medicare and Medicare Advantage plans cover individuals living in two states, including network restrictions, pharmacy access, and telehealth benefits.
Middletown faces scrutiny over unclear public spending and infrastructure planning, while Rhode Island Medicare Advantage plans drop key hospitals from network, impacting patient costs and care continuity.
Medicare Advantage plans serving 30 million Americans may face cuts or changes due to rising medical utilization and costs. This impacts benefits, networks, and out-of-pocket costs, making the Medicare Annual Election Period critical for plan comparisons.
Clover Health launches a New Jersey pharmacy pilot targeting medication adherence and hospitalization cuts to improve Medicare Advantage margins and unlock growth potential.
The DOJ is probing UnitedHealth Group's Medicare Advantage payment practices, with focus on diagnosis coding and compliance. The investigation involves FBI and HHS and impacts stock value amid healthcare sector scrutiny.
