CVS Health may be looking to split its retail and insurance branches following pressure from investors to improve performance. The company is also facing a hefty bill from an audit by the U.S. Department of Health and Human Services Office of Inspector General (OIG) that found it owes millions in overpayments.
CVS's profit margins at...
As the popularity of Medicare Advantage has risen, so has scrutiny from the public and regulators. This week, the Wall Street Journal and KFF published analyses into two aspects of the financial success of Medicare Advantage plans.
In 2023, Medicare Advantage excelled in the metric known as gross margins, which means that MA plans...
Last week, the Private Equity Stakeholder Project (PESP) published a study on the role of private equity (PE) in Medicare Advantage. The study found that PE investment has fallen since the increase of interest rates and the implementation of stricter regulations.
The study looked at PE activity between 2016 and 2023, and analyzed...National News
Another new year, another report from the Medicare Payment Advisory Commission (MedPAC) saying that Medicare Advantage is more expensive in exchange for lower quality coverage.
This year, the commission found that the federal government will pay Medicare Advantage (MA) insurers $88 billion more than it would if their share of...National News
The Medicare system is on a crash course toward insolvency, and the evidence is mounting that overpayments to Medicare Advantage plans and the use of pharmacy benefit managers (PBMs) are responsible for a great deal of those overpayments.
Two researchers, Steven Lieberman and Paul Ginsberg, Ph.D, published a study earlier this year...
Medicare Advantage officially has 30 million enrollees. But with great patient volume comes great responsibility according to the Centers for Medicare and Medicaid Services (CMS), which has pledged tougher audits while finalizing tougher rules for MA plans.
The announcement that MA had crossed the 30 million enrollees mark was made...
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...National News
Better Medicare Alliance (BMA) this week released their annual “State of Medicare Advantage” report, which, in their words, shows “near-universal satisfaction, greater consumer savings, and better health outcomes in Medicare Advantage, as compared to Traditional FFS Medicare.”
It reveals there are now 26 million...National News
UnitedHealthcare won its case over a 2014 rule implemented by the Centers for Medicare and Medicaid Services (CMS) requiring that Medicare Advantage organizations report and return any identified overpayments. The rule was deemed arbitrary and capricious.
U.S. District Court Judge Rosemary Collyer vacated the rule in its entirety,...
