The U.S. Department of Justice has filed suit against three of the largest health insurers for an alleged scheme in which they paid kickbacks to brokers for steering Medicaid beneficiaries into their Medicare Advantage plans.
The lawsuit was filed in Boston federal court earlier this week and targets the insurance giants for engaging...
More insurers are planning to jump the Medicare Advantage ship, or at least scale back program participation in 2025.
It's anticipated that next year will bring fewer MA plans and supplemental benefit offerings following increased oversight by the Biden administration on overpayments to MA companies, which will lead to a projected...
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced last month that it would investigate the use of prior authorization in denials for post-acute care by Medicare Advantage plans.
In the new audit, OIG plans to look into processes for reviewing prior authorization requests for post-acute...
Nursing home advocacy groups have filed a lawsuit against the Biden administration's federal staffing minimum rule, which was promised in the wake of the devastation in nursing homes and exacerbation of nursing staff shortages caused by the COVID-19 pandemic.
It should come as no surprise that the American Health Care Association...National News
The National Association of Accountable Care Organizations (NAACOS), a nonprofit which represents accountable care organizations (ACOs), uncovered a Medicare fraud scheme that may have cost the government $2 billion.
Federal officials are now investigating the fraudulent billing of nearly 406,000 patients for catheters. The Washington...
A new audit conducted by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) found that between 2015 and 2016, insurer Aetna received $25.5 million in Medicare Advantage overpayments. Also, plans are developing new offerings that aim to target the needs of specific demographics.
The OIG audit...
As regulators make efforts to rein in prior authorization delays and denials by private insurers and Medicare Advantage (MA) plans, Medicare and Medicaid managed care organizations (MCOs) are also garnering scrutiny over denials and network adequacy.
A new consumer survey from Kaiser Family Foundation (KFF) found that roughly 60% of...
On Monday, the Biden administration announced that it would end the COVID-19 public health emergency (PHE) declaration. The announcement came as the U.S. House of Representatives passed two bills that would curb federal authority in pandemic response. In Arizona, legislators are pushing bills that would ban schools from requiring...
Nursing homes continue to experience the worst job loss of any other healthcare sector according to new analysis from the Bureau of Labor Statistics (BLS), but Congress is cautioning against the use of skilled nursing facility (SNF) staffing minimums planned by the Centers for Medicare and Medicaid Services (CMS). Also, CMS is working to...
Last week, Kaiser Health News (KHN) won a lawsuit with the Centers of Medicare and Medicaid Services (CMS) to compel the agency to release 90 federal audits of Medicare Advantage (MA) plans from the years 2011 through 2013.
The information contained in these audits demonstrates that overpayments have consistently been made to...
There will likely be a winter surge of COVID-19 in the next few months, but Americans aren't receiving the bivalent booster shot that targets Omicron variants.
The daily global COVID-19 infection rate is expected to rise by two million daily cases by February, according to an analysis from the University of Washington. Reuters notes...
As seniors, the Centers for Medicare and Medicaid Services (CMS) and Medicare Advantage (MA) plans gear up for a landmark Medicare Advantage Open Enrollment Period beginning October 15, Medicare Advantage on the whole is in hot water.
Last week, the New York Times published an earthshaking story documenting the extent to which...
As the Biden administration promised, the U.S. Department of Health Services (HHS) Office of Inspector General (OIG) is sifting through claims submitted by Medicare Advantage (MA) plans, looking for fraudulent activity.
The OIG published two audits this week on Medicare Advantage Compliance of diagnostic codes submitted to the Centers...
On Tuesday, 375 health, tech and telemedical organizations sent a joint letter to leadership of the U.S. Senate requesting action on telehealth legislation prior to the expiration of the COVID-19 public health emergency (PHE). The letter requests an extension to the telehealth policies enacted at the start of the COVID-19 pandemic that...
While Medicare Advantage plans are rapidly gaining steam and moving far faster than predicted to cover over half of eligible Medicare beneficiaries, watchdog scrutiny is ramping up to identify and curb predatory practices that may be harming beneficiaries and the bottom line of the Medicare program.
Last week, the U.S. House Committee...CMS Rules
The Leapfrog Group, a healthcare consumer safety watchdog group, has asked the Centers for Medicare and Medicaid Services (CMS) to revoke plans to end reporting on serious medical and surgical complications that occur in hospitals.
The 2023 Hospital Inpatient Prospective Payment System (IPPS) proposed rule contains within it a measure...
A report last week from the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) highlights the challenges healthcare workers (HCWs) faced during the pandemic, including exhaustion, burnout and trauma.
The report, Impact of the COVID-19 Pandemic on the Hospital and...
Last Thursday, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a report that strongly suggests that Medicare Advantage (MA) plans delayed or denied medical treatments and procedures to beneficiaries that met the Medicare coverage requirements.
Analysts with the Office of the Inspector...
Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) announced proposed payment policy changes for the Medicare Advantage and Part D programs for Calendar Year (CY) 2023. The proposal includes a 7.98% payment increase and health equity provisions for MA participation, for example in star ratings.
The advance notice was...
The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) ran an audit on Aetna's Medicare Advantage (MA) business according to parent company CVS Health. The HHS OIG has cracked down on inaccurate adjustment scores submitted by MA plans including Humana and Anthem.
Aetna's MA reimbursement is...
