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.
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 faces DOJ investigation and Medicare scrutiny amid rising medical costs, yet diversification through Optum supports potential recovery in 2025.
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.
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 plans major expansion of Medicare Advantage RADV audits and proposes rules to limit Medicaid provider taxation practices, impacting insurer compliance and Medicaid financing.
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.
CMS expands Medicare Advantage audits from 2018-2024, intensifying compliance demands and financial scrutiny for major health insurers like UnitedHealth, CVS, and Humana.
The DOJ files a lawsuit accusing insurers and brokerages of illicit kickbacks in Medicare Advantage plan enrollments, raising compliance and regulatory concerns.
UnitedHealthcare stops paying commissions on Medicare prescription drug plans sold after June 1, 2025, impacting agents amid rising Medicare Advantage costs and prompting calls for CMS intervention.
