Optum Develops AI-Based Risk Coding for Medicare Patients Amid DOJ Scrutiny
Optum is creating AI-driven risk coding to improve Medicare patient assessments, coinciding with DOJ investigations into Medicare Advantage practices by UnitedHealth Group.
DOJ Investigates UnitedHealth Group for Potential Medicare Fraud in Medicare Advantage
The DOJ is investigating UnitedHealth Group for alleged criminal Medicare fraud focused on its Medicare Advantage business, highlighting regulatory and compliance risks for health insurers.
Medicaid Cuts Would Increase Medicare Costs and Impact Access to Care
Cutting Medicaid funding shifts costs to Medicare, increasing federal spending and reducing access to care. Learn how Medicaid supports Medicare affordability and prevents costly hospitalizations.
Medicare Inflation Rebates: Extending Protections to Medicare Advantage Enrollees
Analysis of inflation rebate implementation under the Inflation Reduction Act highlights the need to include Medicare Advantage enrollees to maximize drug cost savings and deter pharmaceutical price hikes.
Implications of Proposed Medicaid Cuts on Health Outcomes and Healthcare Costs
Analysis reveals Medicaid funding cuts could worsen health outcomes and increase healthcare costs for low-income and older adults, impacting federal and state budgets.
U.S. Pushes ‘Most Favored Nation’ Drug Pricing Policy Amid Legal and Industry Challenges
The U.S. administration advances a 'most favored nation' drug pricing policy to align Medicare prices with global low points, aiming to reduce prescription costs amid industry resistance and anticipated legal challenges.
U.S. Takes Steps to Lower Drug Prices Through Executive Order and Medicare Negotiations
President Trump's executive order and CMS initiatives mark significant moves to reduce drug prices through broadened Medicare price negotiations including Part B drugs, impacting pharmaceutical industry dynamics and regulatory compliance.
CMS Narrows Medicare Drug Price Negotiation Timeline for Hyluronidase-Enhanced Biologics
CMS accelerates Medicare price negotiations for drugs with hyaluronidase, impacting biologic drug pricing and pharmaceutical companies like Halozyme Therapeutics and Johnson & Johnson.
CCS AI Platform Enhances CGM Adherence, Saves Over $10M in Medicare Diabetes Care
CCS’s AI-driven PropheSee™ platform significantly improves CGM adherence in Medicare diabetes patients, saving $10M+ and advancing preventive chronic care.
CMS Finalizes 2026 Updates for Medicare Advantage and Part D Programs
CMS issued final rules and updates for Medicare Advantage and Part D programs for 2026, including Inflation Reduction Act implementations and inpatient care protections.