Medicare - Health Care Compliance Brief

CMS expands audits to crack down on Medicare Advantage overpayments

Healthcare Dive

MAY 22, 2025

The agency said it would increase the number of MA plan audits and complete its backlog of reviews by investing in technology and growing its medical coding workforce.

Overpayments

Overpayments Overpayment Medicare Medicare

HHS watchdog accuses CVS Medicare Advantage plan of upcoding

Healthcare Dive

JUNE 11, 2025

The vast majority of diagnoses codes that CVS subsidiary Coventry submitted to the CMS between 2018 and 2019 weren’t supported by patient documentation, the HHS Office of the Inspector General found.

CMS expands audits to crack down on Medicare Advantage overpayments

HHS watchdog accuses CVS Medicare Advantage plan of upcoding

Webinars

Trending Sources

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

Webinars

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

Simplify Screening for Excluded Providers

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

Physicians, hospitals decry 2025 Medicare payment rates

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

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

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

Understanding Medicare Coordination of Benefits (COB)

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

PointClickCare Launches Transitions of Care Solution to Reduce Medicare Readmissions

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

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

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

Loss of Subsidized Drug Coverage and Mortality among Medicare Beneficiaries

CMS recalculates Medicare Advantage stars for UnitedHealth, Centene

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

Revitalizing Medicare Advantage: How The Push to Streamline Prior Authorization Will Impact Senior Care

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

Stay Connected