CMS Expands Medicare Advantage Audits to Address $43B Overpayments
CMS is intensifying Medicare Advantage audits to recover $43 billion in overpayments, impacting provider contracts and regulatory compliance across the MA ecosystem.
UnitedHealth Lowers Profit Outlook Amid Medicare Advantage Cost and Coding Challenges
UnitedHealth Group cuts profit forecasts due to higher Medicare Advantage care costs and lower coding revenue, highlighting challenges in Medicare Advantage management and insurance financials.
Johns Hopkins ACG® System Enhances Population Health Analytics for Over 250 Million Weekly
The Johns Hopkins ACG System is a leading population health analytics tool used globally to improve care for over 250 million people weekly, integrating clinical and social data to advance health equity and risk adjustment.
UnitedHealth Group Faces Profitability Challenges in OptumHealth Amid Medicare Advantage Utilization Spike
UnitedHealth Group reports significant OptumHealth underperformance driven by higher Medicare Advantage utilization and risk adjustment challenges, raising profitability concerns and prompting strategic prioritization of patient engagement.
Reveleer Expands AI-Driven Value-Based Care Platform with Novillus Acquisition
Reveleer acquires Novillus to enhance its AI-driven value-based care platform, improving payer-provider collaboration, care gap closure, and clinical intelligence for health plans.
Medicare Advantage Costs, Challenges, and Broker Roles: Insights from SCAN Health Plan CEO
Medicare Advantage increases federal spending but offers lower out-of-pocket costs for seniors. SCAN CEO Sachin Jain highlights program flaws, risk adjustment abuses, and broker roles.
UnitedHealth Group Faces Medicare Advantage Utilization and Payment Challenges in Q1 2025
UnitedHealth Group's Q1 2025 earnings reveal increased Medicare Advantage care utilization and regulatory payment changes impacting financial performance, highlighting challenges in the evolving health insurance market.