OIG Report Reveals Underreporting of Major Injury Falls in Medicare Nursing Homes
OIG finds nursing homes underreporting major injury falls affecting accuracy of CMS Care Compare data; CMS to enhance compliance and reporting measures.
UnitedHealth Projects 78% of Medicare Advantage Members in 4-Star+ Plans for 2027
UnitedHealth expects about 78% of its Medicare Advantage members to be enrolled in plans rated four stars or above in 2027, signaling strong quality performance under CMS metrics.
NY Medical Supply Firms Accused of Medicare and Insurance Billing Fraud
Two New York medical supply companies face allegations of fraudulent billing to Medicare and insurance agencies, with numerous consumer complaints reported to the BBB.
Efforts Intensify to Combat Medicare Fraud and Protect Program Integrity
Intensified efforts to combat Medicare fraud improve detection and prevention, safeguarding U.S. healthcare insurers and ensuring compliance with federal regulations.
US Health Insurers Pledge to Simplify Prior Authorization by 2027
Major US health insurers commit to streamlining prior authorization to speed medical approvals and reduce patient/provider friction by 2027.
New Medicare Initiative Aims to Stop $60B in Fraud Losses
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.
Congress Calls for GAO Probe into Medicare Advantage Plan Acquisitions
U.S. Representatives urge a probe into Medicare Advantage plans acquiring health businesses, potentially affecting compliance with medical loss ratio standards.