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.
Medicare Weight Loss Drug Coverage: Legislative and Regulatory Paths
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 Proposes 2026 Medicare Telehealth Enhancements Including Behavioral Health and Remote Monitoring
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.
Restrictive Insurance Coverage Linked to Increased MS Relapse Rates
Study reveals limited insurance coverage for multiple sclerosis drugs increases relapse risk, highlighting Medicare plan disparities and formulary restrictions.
Key Medicare Part A Criteria for Skilled Nursing Facility Coverage Explained
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.
Medicare Wastes $3.6 Billion Annually on Low-Value Care, Study Finds
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 Proposes 2026 Medicare Physician Fee Schedule With Focus on Value and Telehealth
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.
Legislative Changes Delay Medicare Drug Price Negotiations for Expensive Cancer Medications
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 Medicare Learning Network Web-Based Training Supports Provider Education
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.
CMS Revisits GLP-1 Drug Coverage for Obesity in Medicare, Medicaid Pilot
CMS is considering a pilot program to cover GLP-1 drugs for obesity under Medicare and Medicaid, reversing earlier policy. This evolving coverage changes obesity drug access for patients and payers.