The OIG's audit reveals significant noncompliance with PDPM billing in skilled nursing facilities, prompting potential repayments exceeding $31 million and signaling broader risks for Medicare reimbursement compliance.
CMS reinstates bonus payments for Medicare Advantage plans and proposes removing administrative star rating measures, impacting key insurers like Humana and UnitedHealth Group.
Krishna Gidwani pleaded guilty to conspiracy in a $4M Medicare fraud involving durable medical equipment. Part of DOJ's 2025 National Health Care Fraud Takedown.
CenterWell's bid for Florida provider TVH during bankruptcy underscores insurer strategies in Medicare compliance and primary care integration.
Discover how proposed domestic policy legislation may reduce Medicare payments, expand HSA eligibility for employed seniors, and enhance rural hospital designations, reshaping Medicare coverage and funding starting 2026.
CMS extends skilled nursing facilities' Medicare revalidation deadline to August 2025 amid new ownership disclosure requirements to improve care quality oversight.
Holly Hill mental health hospital in North Carolina addresses CMS and NCDHHS compliance issues to maintain Medicare program eligibility. Follow-up inspection results pending.
