IQVIA study reveals Medicare Part D plans frequently deny initial access to medications for chronic conditions, highlighting payer policy and compliance challenges.

Senate Republicans advance aggressive Medicaid cuts for low-income and disabled populations while sparing Medicare Advantage insurers, impacting health insurance markets.

The Senate Finance Committee's health care and tax bill proposes stricter Medicaid funding limits, altered Medicare and tax policies, with key effects for expansion versus non-expansion states.

AHIP highlights risks to Medicaid coverage and individual market stability in the Senate Finance Committee's budget reconciliation proposal, urging Congress to preserve affordable access and competition.

U.S. Senate Republicans are reviewing Medicare Advantage upcoding practices to reduce federal spending and support tax cut proposals, focusing on reforming provider payment inflation.

A California physician was sentenced for a $1.5 million Medicare home health care fraud involving false certifications and fraudulent billing. The case underscores critical compliance challenges in Medicare billing processes.

Medicare loses $60 billion annually to fraud, impacting beneficiaries' health and the program's finances. Senior Medicare Patrol leads prevention education during Medicare Fraud Prevention Week.

MedPAC calls for federal reform of nursing home Five-Star ratings, emphasizing staffing and alternative quality metrics to improve long-term care under Medicare.

Medicare Advantage plans cost taxpayers 22% more per enrollee than traditional Medicare. Understanding payment system flaws and reform options is critical for policymaker and insurer strategy.

Mercy and Humana collaborate to open 65 Prime+ clinics in Missouri, enhancing Medicare senior care with tailored primary care services and expanded access to Medicare Advantage plans.