CMS Expands Medicare Advantage Audits to Address $43B Overpayments
CMS is intensifying Medicare Advantage audits to recover $43 billion in overpayments, impacting provider contracts and regulatory compliance across the MA ecosystem.
Hospice Industry Faces Regulatory and Medicare Advantage Integration Challenges in 2025
Hospices confront rising operational costs, increased audits, and potential Medicare Advantage coverage changes in 2025, impacting hospice care delivery and financial sustainability.
SCAN Wins 2025 Hearst Health Prize for Innovative Medicare Advantage Care Platform
SCAN received the 2025 Hearst Health Prize for its PATH platform, enhancing home-based primary care with data integration and risk stratification for Medicare Advantage seniors.
2025 Medicare Advantage Star Ratings Drop Spurs Health IT Innovation Across Payers
The 2025 decline in Medicare Advantage Star Ratings intensifies regulatory scrutiny. Black Book Research reveals health IT strategies top plans use to boost quality, member experience, and compliance across all payers.
DOJ Files False Claims Act Complaint Against GoHealth Over Medicare Advantage Kickbacks
The DOJ has filed a False Claims Act complaint against GoHealth, alleging illegal kickbacks to brokers for Medicare Advantage enrollments, triggering a securities investigation and stock decline.
UnitedHealth Eyes Recovery Amid Medicare Scrutiny and Rising Costs
UnitedHealth faces DOJ investigation and Medicare scrutiny amid rising medical costs, yet diversification through Optum supports potential recovery in 2025.
UnitedHealth Group Under Federal Scrutiny Amid Medicare Advantage Challenges
UnitedHealth Group faces federal investigations over Medicare Advantage practices amid rising scrutiny of private Medicare plans. Explore the implications for insurance regulation and healthcare market dynamics.
DOJ Sues Medicare Advantage Insurers for Kickback and Discriminatory Practices
The DOJ has filed a lawsuit against major Medicare Advantage insurers for an alleged kickback scheme and discriminatory enrollment practices affecting beneficiaries with disabilities. The case highlights regulatory issues and market conduct in private Medicare plans.
CMS Amplifies Medicare Advantage RADV Audits and Targets Medicaid Provider Taxes
CMS plans major expansion of Medicare Advantage RADV audits and proposes rules to limit Medicaid provider taxation practices, impacting insurer compliance and Medicaid financing.
CMS Intensifies Medicare Advantage Audits, LTC Research Highlights, and Nursing Home Compliance Issues
CMS escalates Medicare Advantage audits targeting upcoding and overpayments; research shows benefits of closer heart failure patient monitoring to reduce rehospitalizations; federal probe into nursing home COVID policies; nursing home financial fraud uncovered.