Impact of Fifth Circuit Ruling on Hospital Payments and 340B Eligibility
Explore the Fifth Circuit's ruling affecting hospital payments and 340B eligibility, highlighting key regulatory compliance challenges for healthcare providers.
Basys.ai Named CMS National Finalist for AI-Driven Fraud Detection in Medicare
Basys.ai recognized by CMS as a national finalist in the Crushing Fraud, Waste, and Abuse Challenge for its AI-powered prior authorization platform improving Medicare fraud detection and healthcare affordability.
Key Medicare Advantage Plan Considerations for 2026 Enrollment
Explore critical factors for Medicare Advantage plan enrollees in 2026, including costs, provider networks, telehealth options, and out-of-pocket limits to optimize coverage and compliance.
Georgia Man Sentenced for $7.2M Medicare Genetic Testing Kickback Scheme
Patrick C. Moore Jr. sentenced to 46 months and ordered to pay $7.2 million for leading a Medicare genetic testing kickback scheme involving medically unnecessary tests. DOJ and HHS-OIG investigations highlight DOJ's ongoing enforcement against health care fraud.
Georgia Man Sentenced for Illegal Medicare Genetic Testing Kickback Scheme
Georgia man sentenced to 46 months and $7.2M restitution for illegal Medicare kickbacks tied to unnecessary genetic tests, reflecting enforcement on healthcare fraud.
OIG Uncovers Major PDPM Billing Noncompliance in Skilled Nursing Audit
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.
Massachusetts Man Pleads Guilty in $4M Medicare DME Fraud Scheme
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 Preliminary Bid in Florida Provider Bankruptcy Highlights Strategic Expansion
CenterWell's bid for Florida provider TVH during bankruptcy underscores insurer strategies in Medicare compliance and primary care integration.
Key Medicare Reforms in Proposed Domestic Policy Bill Impact Payments and Coverage
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 Facility Medicare Revalidation Deadline to August 2025
CMS extends skilled nursing facilities' Medicare revalidation deadline to August 2025 amid new ownership disclosure requirements to improve care quality oversight.