Medicare - Health Care Compliance Brief

Mind the gap: How lab partners can help Part C plans adapt to Medicare Star Rating changes

Healthcare Dive

MAY 5, 2025

A 1-star boost in Medicare ratings can add up to $16.2M in revenue and 8–12% enrollment growth.

Medicare

Medicare Medicare

Medicare Advantage plans received billions from Medicare for home visits. The feds are skeptical

Fierce Healthcare

OCTOBER 24, 2024

Medicare Advantage (MA) insurers, namely industry titans UnitedHealth Group and Humana, could be using health risk assessments and chart reviews to inflate payments from Medicare through upcoding, | A federal watchdog is questioning whether UnitedHealthcare, Humana and other Medicare Advantage payers are either creating diagnoses out of thin air to (..)

Medicare

Medicare Medicare

RFK Jr. appears confused about Medicaid, Medicare during confirmation hearing

Healthcare Dive

JANUARY 29, 2025

incorrectly said that Medicaid was fully funded by the federal government and that Medicare is a fee-for-service program during a hearing in front of the Senate Finance Committee on Wednesday. Kennedy Jr.

Medicaid

Medicaid Medicaid Medicare Medicare

Physicians, hospitals decry 2025 Medicare payment rates

Healthcare Dive

NOVEMBER 4, 2024

Physicians will see their Medicare reimbursement fall 2.9% next year if Congress doesn’t stop the cuts. Meanwhile, reimbursement for hospital outpatient departments is rising 2.9%.

Medicare

Medicare Medicare Hospitals

Simplify Screening for Excluded Providers

Payments from Medicare, Medicaid, and TriCare trigger screening requirements that may extend to employees, contractors, volunteers, board members, and network providers. Every health care provider that accepts federal payments must screen for excluded providers. Make sure your screening procedures cover all your bases.

Medicaid

Amazon expands drug subscription program to Medicare members

Healthcare Dive

JUNE 18, 2024

RxPass is now available to more than 50 million Medicare members after Amazon brought it into compliance with the insurance program’s regulatory standards.

Medicare

Medicare Medicare Compliance

Humana inks minority investment in Medicare choice tool Healthpilot

Healthcare Dive

JULY 18, 2024

The company uses AI to recommend Medicare Advantage, Medicare supplement and prescription drug plans based on enrollees’ healthcare preferences and needs.

Medicare

Medicare Medicare

Remote patient monitoring in Medicare needs more oversight: OIG

Healthcare Dive

SEPTEMBER 25, 2024

Regulators say Medicare needs more data and oversight to avoid fraud and misuse. Digital health advocates argue the service is still crucial for managing chronic conditions.

Medicare

Medicare Medicare Fraud

Cigna closes $3.7B sale of Medicare business to HCSC

Healthcare Dive

MARCH 20, 2025

The deal, which removes Cigna from the volatile Medicare Advantage market, closed a little over a year after being announced.

Medicare

Medicare Medicare

RFK Jr. fumbles Medicare basics during second confirmation hearing

Healthcare Dive

JANUARY 30, 2025

nominee for HHS secretary, seemed unfamiliar with the massive insurance program during Thursday’s hearing, mistakenly saying Medicare Part A mainly paid for primary care or physicians. Kennedy Jr.,

Medicare

Medicare Medicare

Semaglutide coverage for weight loss could cost Medicare billions: study

Healthcare Dive

AUGUST 27, 2024

If all newly eligible patients received semaglutide, Medicare Part D spending could increase by $34 billion to $145 billion each year, according to new research.

Medicare

Medicare Medicare

Democrats urge Republicans to focus on Medicare Advantage upcoding instead of Medicaid cuts

Healthcare Dive

MAY 9, 2025

Stopping MA insurers from inflating their reimbursement is a better strategy to save federal dollars than restricting benefits or cutting eligibility in Medicaid, the Democrat lawmakers wrote to GOP leadership this week.

Medicaid

Medicaid Medicaid Medicare Medicare

Medicare to cover Novo’s obesity drug for some patients

Healthcare Dive

MARCH 22, 2024

Two weeks after the FDA updated Wegovy’s label, Medicare changed its stance to allow people with a history of heart disease to receive treatment, a shift that could further boost access to the fast-selling medicine.

Medicare

Medicare Medicare FDA

MA spending to outstrip traditional Medicare by $88B this year: MedPAC

Healthcare Dive

JANUARY 16, 2024

MedPAC released the data Friday during a contentious meeting where members argued over the efficacy of Medicare Advantage.

Medicare

Medicare Medicare

CMS to get ‘tougher’ on Medicare Advantage, official promises

Healthcare Dive

SEPTEMBER 22, 2023

CMS Deputy Administrator Jon Blum signaled regulators could increasingly crack down on bad actors in the MA program, which now covers more than half of Medicare seniors.

Medicare

Medicare Medicare

Humana sues HHS over Medicare Advantage audits

Healthcare Dive

SEPTEMBER 5, 2023

The payer, which brings in the bulk of its revenue from Medicare, is fighting back against a rule finalized earlier this year to claw back overpayments in the increasingly popular MA program.

Medicare

Medicare Medicare Overpayments Overpayment

CMS revised Medicare Advantage star ratings. Here’s which payers benefited.

Healthcare Dive

JULY 9, 2024

More than 60 Medicare Advantage health plans from 40 insurers have received a higher star rating for 2024, according to a Healthcare Dive analysis.

Medicare

Medicare Medicare

Dr. Oz vows to scrutinize Medicare Advantage as CMS head

Healthcare Dive

MARCH 17, 2025

Mehmet Oz, who has previously advocated for expanding the privatized Medicare program, said he would tackle upcoding among MA plans if confirmed.

Medicare

Medicare Medicare

CMS to lower importance of ‘call center’ metric in Medicare Advantage star ratings

Healthcare Dive

NOVEMBER 14, 2024

But the metric “is going to have a smaller weighting on star ratings moving forward,” the director of Medicare said. Regulators’ assessment of customer support centers has spurred recent lawsuits from UnitedHealthcare, Centene and Humana.

Medicare

Medicare Medicare

CMS holds accountable care organizations harmless for ‘highly suspect’ Medicare billing

Healthcare Dive

SEPTEMBER 25, 2024

Aberrant billing for urinary catheters last year could have made it harder for ACOs in Medicare to bring in shared savings. That’s no longer the case under a new final rule.

Medicare

Medicare Medicare

Medicare Advantage growth slows as UnitedHealthcare nabs members, Humana sheds lives

Healthcare Dive

FEBRUARY 26, 2025

The CMS released highly anticipated MA enrollment data on Tuesday that showed UnitedHealth further tightening its grip on the privatized Medicare market.

Medicare

Medicare Medicare

Cigna is still interested in Medicare

Healthcare Dive

FEBRUARY 2, 2024

The health insurer sees Medicare Advantage as an area for future growth, despite selling the division for $3.7 billion earlier this week. Cigna’s CEO called the sale a “win-win” on a call with investors Friday.

Medicare

Medicare Medicare Health Insurance

Medicare Advantage beneficiaries receive fewer home health visits, study finds

Healthcare Dive

MARCH 5, 2024

Medicare Advantage beneficiaries were also less likely to improve self-care and mobility function, according to research published in JAMA Health Forum.

Medicare

Medicare Medicare

CMS puts forward meager offering for digital health in final Medicare physician fee schedule rule

Fierce Healthcare

NOVEMBER 4, 2024

Days before the 2024 presidential election, the Centers for Medicare & Medicaid Services (CMS) released an unpublished version of the final calendar year 2025 physician fee schedule final rule | Digital therapeutics, telehealth, rural heath clinics and opioid treatment programs all got updates in the final 2025 Medicare physician fee schedule rule, (..)

Medicare

Medicare Medicare Medicaid Medicaid

Insurer lobby blames government policies for 2025 Medicare Advantage market makeup

Healthcare Dive

OCTOBER 23, 2024

The Better Medicare Alliance is warning of disruptions to care for America’s seniors, though MA premiums and major benefits are essentially unchanged next year.

Medicare

Medicare Medicare Governance

Healthpilot and Publix Partner to Simplify Medicare Plan Selection for Seniors

HIT Consultant

NOVEMBER 13, 2024

What You Should Know: – Healthpilot , an AI-powered Medicare comparison platform, and Publix Supermarkets have joined forces to simplify the process of choosing Medicare plans for seniors. Addressing the Complexity of Medicare Choices Navigating the Medicare landscape can be overwhelming for seniors. ”

Medicare

Medicare Medicare Licensing

Senate Finance Committee tackles Medicare physician pay reform

Healthcare Dive

MAY 20, 2024

On Friday, the committee released a white paper proposing Medicare adjust doctor reimbursement to account for inflation, a key goal for physician lobbies.

Medicare

Medicare Medicare Doctors

PointClickCare Launches Transitions of Care Solution to Reduce Medicare Readmissions

HIT Consultant

MARCH 11, 2025

– The solution aims to help Medicare Advantage plans improve their TRC Star measure performance by automating the access and delivery of critical admission and discharge information. The new solution addresses the significant issue of hospital readmissions among Medicare beneficiaries. billion annually.

Medicare

Medicare Medicare Medicaid Medicaid

Medicare Advantage unrest, Change Healthcare fallout and more big takeaways from insurers’ Q1

Healthcare Dive

MAY 13, 2024

All major payers saw elevated utilization but only an unprepared few struggled with the trend, the Change Healthcare cyberattack caused minimal financial fallout and a new D-SNP rule opens the door to a Medicare growth opportunity.

Medicare

Medicare Medicare

CMS finalizes 2024 Medicare hospital, doctor payments, 340B fix and price transparency requirements

Healthcare Dive

NOVEMBER 3, 2023

Regulators finalized a number of rules Thursday with sweeping implications for providers in the Medicare program, including rates for next year that doctors and hospitals slammed as insufficient.

Doctors

Doctors Medicare Medicare Hospitals

CMS says private Medicare plans can’t automatically deny Biogen’s ALS drug

Healthcare Dive

DECEMBER 13, 2024

agency behind Medicare is warning Medicare Advantage providers they can’t have blanket policies that deny coverage of Qalsody because it’s “experimental and investigational.” In a rare move, the U.S.

Medicare

Medicare Medicare

Medicare saves record $2.1 billion from largest accountable care program

Healthcare Dive

OCTOBER 31, 2024

Citrus ACO in Central West Florida had the highest savings rate, while Health Connect Partners — an ACO operated by hospital giant Providence — had the highest total savings in the Medicare Shared Savings Program last year.

Medicare

Medicare Medicare Hospitals

Medicare go-broke date extended to 2036, but warning bells continue ringing

Healthcare Dive

MAY 7, 2024

The Medicare trustee’s new deadline for the trust fund’s insolvency is five years later than in last year’s report, but budget hawks warned action is still needed to shore up the insurance program’s finances.

Medicare

Medicare Medicare

Medicare drug price cuts could have limited early impact, but grow with time

Healthcare Dive

AUGUST 16, 2024

Some industry watchers described the level of price discounts announced by Medicare as a "relief," though they warned of bigger future implications for drug research.

Medicare

Medicare Medicare

How Medicare Advantage Programs Can Address Social Risk and Improve Health Outcomes

HIT Consultant

DECEMBER 23, 2024

Brian Norris, Managing Director of Strategic Consulting at MedeAnalytics There are almost 33 million people enrolled in eligible Medicare programs. Nearly half are enrolled in Medicare Advantage (MA) plans, and that number is expected to continue its climb.

Health Outcomes

Health Outcomes Medicare Medicare Patient Satisfaction

CMS recalculates Medicare Advantage stars for UnitedHealth, Centene

Healthcare Dive

DECEMBER 4, 2024

After both insurers challenged the agency in court, the CMS improved scores for 12 UnitedHealth contracts and seven Centene contracts.

Medicare

Medicare Medicare

Medicare Counseling Coverage Explained

Medisys Compliance

MARCH 9, 2025

Understanding Medicare coverage for counseling can feel particularly challenging, but it is crucial. Many providers find themselves asking: What exactly does Medicare cover when it comes to outpatient mental health counseling services? This cornerstone of outpatient mental health care is generally well-covered by Medicare.

Medicare

Medicare Medicare Medical Billing Medical Billing Services

How AI Can Accelerate and Ensure Accuracy when Translating Medicare Advantage Materials

Healthcare IT Today

APRIL 4, 2025

Translation of member materials is an onerous burden for Medicare Advantage Organizations (MAOs). For Dual Special Needs Plans (DSNPs), compliance is even more complex as they must meet both Medicare and Medicaid translation requirements, supporting as many as 24 languages in some states.

Medicare

Medicare Medicare Medicaid Medicaid

DOJ accuses CVS, Humana, Elevance of paying kickbacks to Medicare Advantage brokers

Healthcare Dive

MAY 1, 2025

According to the Justice Department’s complaint, the insurers paid brokers eHealth, GoHealth and SelectQuote hundreds of millions of dollars for enrolling seniors in their MA coverage — regardless of the plans’ suitability for those members’ needs.

Medicare

Medicare Medicare

Navigating Medicare Billing: A Physician’s Guide

Medisys Compliance

MARCH 31, 2025

Introduction For many physician practices, Medicare beneficiaries represent a significant portion of their patient population. However, navigating the complexities of Medicare billing can be a challenging task, especially when considering its distinct differences from private insurance models.

Medicare

Medicare Medicare Medical Billing Medical Billing Outsourcing

Congress extends Medicare telehealth flexibilities for 6 months

Healthcare Dive

MARCH 18, 2025

Telehealth groups celebrated the extension, but added the short-term reprieve means continued uncertainty for providers.

Medicare

Medicare Medicare

Medicare reveals results of drug price negotiations

Healthcare Dive

AUGUST 15, 2024

The agency said the first round of pricing talks, which involved drugs like the blood thinners Eliquis and Xarelto, will result in $6 billion in savings for taxpayers.

Medicare

Medicare Medicare

Medicare Advantage prior authorization denials increased in 2022: KFF

Healthcare Dive

AUGUST 14, 2024

More than 80% of denied requests were overturned when appealed, but few beneficiaries formally questioned the decisions.

Medicare

Medicare Medicare

Medicare finalizes higher 2.9% inpatient payment rate for 2025

Healthcare Dive

AUGUST 2, 2024

Hospitals still weren’t happy with the final rule despite the bump from the CMS’ proposed rates, citing cuts to long-term and disproportionate share facilities.

Medicare

Medicare Medicare Hospitals

Mind the gap: How lab partners can help Part C plans adapt to Medicare Star Rating changes

Medicare Advantage plans received billions from Medicare for home visits. The feds are skeptical

Trending Sources

RFK Jr. appears confused about Medicaid, Medicare during confirmation hearing

Physicians, hospitals decry 2025 Medicare payment rates

Simplify Screening for Excluded Providers

Amazon expands drug subscription program to Medicare members

Humana inks minority investment in Medicare choice tool Healthpilot

Remote patient monitoring in Medicare needs more oversight: OIG

Cigna closes $3.7B sale of Medicare business to HCSC

RFK Jr. fumbles Medicare basics during second confirmation hearing

Semaglutide coverage for weight loss could cost Medicare billions: study

Democrats urge Republicans to focus on Medicare Advantage upcoding instead of Medicaid cuts

Medicare to cover Novo’s obesity drug for some patients

MA spending to outstrip traditional Medicare by $88B this year: MedPAC

CMS to get ‘tougher’ on Medicare Advantage, official promises

Humana sues HHS over Medicare Advantage audits

CMS revised Medicare Advantage star ratings. Here’s which payers benefited.

Dr. Oz vows to scrutinize Medicare Advantage as CMS head

CMS to lower importance of ‘call center’ metric in Medicare Advantage star ratings

CMS holds accountable care organizations harmless for ‘highly suspect’ Medicare billing

Medicare Advantage growth slows as UnitedHealthcare nabs members, Humana sheds lives

Cigna is still interested in Medicare

Medicare Advantage beneficiaries receive fewer home health visits, study finds

CMS puts forward meager offering for digital health in final Medicare physician fee schedule rule

Insurer lobby blames government policies for 2025 Medicare Advantage market makeup

Healthpilot and Publix Partner to Simplify Medicare Plan Selection for Seniors

Senate Finance Committee tackles Medicare physician pay reform

PointClickCare Launches Transitions of Care Solution to Reduce Medicare Readmissions

Medicare Advantage unrest, Change Healthcare fallout and more big takeaways from insurers’ Q1

CMS finalizes 2024 Medicare hospital, doctor payments, 340B fix and price transparency requirements

CMS says private Medicare plans can’t automatically deny Biogen’s ALS drug

Medicare saves record $2.1 billion from largest accountable care program

Medicare go-broke date extended to 2036, but warning bells continue ringing

Medicare drug price cuts could have limited early impact, but grow with time

How Medicare Advantage Programs Can Address Social Risk and Improve Health Outcomes

CMS recalculates Medicare Advantage stars for UnitedHealth, Centene

Medicare Counseling Coverage Explained

How AI Can Accelerate and Ensure Accuracy when Translating Medicare Advantage Materials

DOJ accuses CVS, Humana, Elevance of paying kickbacks to Medicare Advantage brokers

Navigating Medicare Billing: A Physician’s Guide

Congress extends Medicare telehealth flexibilities for 6 months

Medicare reveals results of drug price negotiations

Medicare Advantage prior authorization denials increased in 2022: KFF

Medicare finalizes higher 2.9% inpatient payment rate for 2025

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