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Preventing Genetic Testing Fraud: 5 Actions for Health Plans

Healthcare IT Today

billion by 2026 , driven in part by direct-to-consumer testing for health risks such as breast cancer and physician orders for prenatal testing, tumor molecular profiling and sequencing to diagnose rare disease. The surge in genetic testing claims comes with a rise in fraud, waste and abuse across government and commercial payers.

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CMS Issues CY2024 Proposed Rule for Medicare Advantage Organizations and Part D Sponsors

Healthcare Law Blog

The Proposed Rule includes changes on an array of topics including: Star Ratings, medication therapy management, marketing and communications, health equity, provider directories, coverage criteria, prior authorization, behavioral health services, identification of overpayments , requirements for valid contract applications, and formulary changes.