CMS's price-substitution policy has saved $76 million for Medicare by correcting drug pricing identified by the Office of Inspector General, improving cost efficiency while maintaining access.
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.
Medicare faces evolving opportunities and challenges in covering weight loss drugs through legislation like the Treat and Reduce Obesity Act and federal demonstration projects. Drug adherence and cost-effectiveness remain key issues.
CMS's 2026 Physician Fee Schedule proposal advances Medicare telehealth with expanded behavioral health codes, remote monitoring updates, and virtual Diabetes Prevention Program delivery, shaping long-term digital care integration.
Study reveals limited insurance coverage for multiple sclerosis drugs increases relapse risk, highlighting Medicare plan disparities and formulary restrictions.
Understand the Medicare Part A requirements for skilled nursing facility coverage, including qualifying hospital stays, coverage limits, and copay costs essential for healthcare professionals and insurers.
New study reveals Medicare spends $3.6 billion annually on low-value medical services, with $800M in patient costs. Policy changes could reduce waste and improve value.
CMS's 2026 Medicare Physician Fee Schedule proposal emphasizes value-based payment increases, expanded telehealth flexibilities, new chronic care payment models, and significant Medicare spending reductions for skin substitutes.
Recent Republican-led legislative changes delay Medicare drug price negotiations for costly cancer treatments, maintaining high patient costs and impacting seniors and disabled Americans.
CMS offers a range of Medicare Learning Network web-based training courses for providers covering billing, coding, fraud prevention, and compliance. Courses are self-paced but do not provide continuing education credits. Subscribe to MLN Connects® for updates.
