Payment Integrity Focus Shifts from Fraud to Preventing Overpayments in Healthcare
CMS reports $86B in improper payments, emphasizing payment integrity's role in preventing overpayments and improving healthcare claims accuracy.
Analysis Reveals Medicaid Spending Waste from Eligibility Verification Lapses
A new analysis reveals extensive Medicaid spending waste tied to weakened eligibility verification rules since 2012 and estimates future improper payments could total $2 trillion. Legislative reforms aim to restore verification and reduce fraud without cutting care for eligible recipients.
CMS Intensifies Medicare Advantage Audits, LTC Research Highlights, and Nursing Home Compliance Issues
CMS escalates Medicare Advantage audits targeting upcoding and overpayments; research shows benefits of closer heart failure patient monitoring to reduce rehospitalizations; federal probe into nursing home COVID policies; nursing home financial fraud uncovered.
Medicare Phone Scams Target Beneficiaries, Prompt Security Alerts
Medicare phone scams are rising, with fraudsters posing as representatives to steal personal info. Learn how insurance professionals can help protect beneficiaries.
Trump Administration's Proposal Targets Obamacare Exchange Fraud, Saving $150B
The Trump administration's new rule aims to reduce fraud and improper payments on Obamacare exchanges, potentially saving $150 billion and lowering premiums by over 5%.
SSA Enhances Telephone Claim Security with New Anti-Fraud Technology
The Social Security Administration enhances security and accessibility for telephone claims with new anti-fraud technology. Learn how this impacts beneficiaries and prevents fraud.