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 284

Medicare Medicare Health Insurance 284

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 261

Medicare Medicare Doctors 261

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 259

Medicare Medicare 259

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 321

Medicare Medicare 321

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 309

Medicare Medicare 309

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 301

Medicare Medicare Overpayment Overpayments 301

Healthcare Dive

APRIL 3, 2023

The date Medicare’s hospital trust fund is expected to run dry has been extended by three years, but stakeholders continue to urge action from Washington to address Medicare’s long-term solvency.

Medicare 318

Medicare Medicare Hospitals 318

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 322

Medicare Medicare 322

Fierce Healthcare

OCTOBER 16, 2024

Medicare's annual enrollment period is officially underway, and, to assist beneficiaries in selecting plans, U.S. Medicare's annual enrollment period is officially underway, and to assist beneficiaries in selecting plans, U.S. News & World Report has released its list of the best Medicare Advantage and Part D insurers.

Medicare 113

Medicare Medicare 113

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 284

Medicare Medicare 284

Healthcare Dive

JANUARY 16, 2024

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

Medicare 339

Medicare Medicare 339

Fierce Healthcare

OCTOBER 10, 2024

Just 40% of Medicare Advantage prescription drug plans offered in 2025 achieved a score of four stars or higher, the Centers for Medicare & Medicaid Services (CMS) revealed Oct. It's harder than ever for Medicare Advantage plans to score well on star ratings. Here's how they performed for 2025.

Medicare 126

Medicare Medicare Medicaid Medicaid 126

Fierce Healthcare

SEPTEMBER 27, 2024

Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the landscape around Medicare Advantage and Part D before si | Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the (..)

Medicare 121

Medicare Medicare Medicaid Medicaid 121

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 305

Doctors Medicare Medicare Hospitals 305

Fierce Healthcare

SEPTEMBER 20, 2024

Cigna is reshaping its Medicare Advantage (MA) plan lineup across eight states, affecting members in 36 health plans. Cigna is the latest company to rethink its Medicare Advantage offerings, choosing to cut plans in eight states including Florida.

Medicare 124

Medicare Medicare 124

Healthcare Dive

DECEMBER 20, 2022

The Government Accountability Office is urging the CMS to resume certain eligibility checks on providers whom they consider at high risk of fraud to the Medicare program.

Fraud 323

Fraud Governance Medicare Medicare 323

Healthcare Dive

JUNE 14, 2023

The figure is almost triple prior estimates of MA overpayments, highlighting the need for payment reform to avoid overtaxing the Medicare system, researchers said.

Overpayment 284

Overpayment Overpayments Medicare Medicare 284

Fierce Healthcare

SEPTEMBER 4, 2024

Humana reaffirmed its full-year guidance but is leaving 13 Medicare Advantage (MA) markets next year, Chief Financial Officer Susan Diamond said during the Wells Fargo Healthcare Conference on Wedn | Humana is pulling back from Medicare Advantage markets and cutting benefits next year.

Medicare 126

Medicare Medicare 126

Healthcare Dive

OCTOBER 11, 2024

About 40% of MA plans with prescription drug coverage will earn four or more stars, a dip from 42% this year, according to data released by the CMS.

Medicare 301

Medicare Medicare 301

Fierce Healthcare

OCTOBER 11, 2024

Analyses of 2025 Medicare Advantage star ratings continue to pour in and not all of it bodes well for the conventional juggernauts. UnitedHealth and Humana saw star ratings decrease, whereas insurtechs celebrated their scores. We break down how all major insurers—and their investors—are reacting.

Medicare 126

Medicare Medicare 126

Healthcare Dive

FEBRUARY 27, 2024

Medicare Advantage payment per month, per beneficiary could drop by 1% next year if regulators finalize rates as proposed, according to the analysis backed by the Better Medicare Alliance.

Medicare 274

Medicare Medicare 274

Healthcare Dive

FEBRUARY 10, 2023

The CMS has laid out how it plans to implement a key provision of the Inflation Reduction Act requiring drugmakers to pay rebates on price hikes in Medicare that are greater than inflation.

Medicare 274

Medicare Medicare 274

Healthcare Dive

JUNE 14, 2024

The House Budget Committee met Thursday and said they’d take action to restore Medicare’s financial footing, though the hearing was light on specifics.

Medicare 157

Medicare Medicare 157

Healthcare Dive

JANUARY 30, 2024

However, growth in Medicare's flagship shared savings model has plateaued over the past five years, according to government data.

Medicare 184

Medicare Medicare Governance 184

Fierce Healthcare

AUGUST 15, 2024

The Centers for Medicare & Medicaid Services offered the first look at the potential savings generated by the first crop of Medicare drug price negotiations. | The Centers for Medicare & Medicaid Services offered the first look at the potential savings generated by the first crop of Medicare drug price negotiations.

Medicare 135

Medicare Medicare Medicaid Medicaid 135

Fierce Healthcare

AUGUST 13, 2024

Fifty-four percent of Medicare beneficiaries are enrolled in a private Medicare Advantage plan, and in seven states that figure tops 60%, according to a new report from KFF.

Medicare 131

Medicare Medicare 131

Healthcare Dive

JUNE 17, 2024

Healthcare payers are leveraging automation and technology to build robust Medicare Advantage networks, overcoming challenges posed by changing deadlines and regulatory complexities.

Medicare 144

Medicare Medicare 144

Healthcare Dive

SEPTEMBER 9, 2022

A small proportion of providers that billed for telehealth — 1,714 out of 742,000 — posed a high risk of fraud or abuse to Medicare in COVID-19’s first year, regulators found.

Fraud 274

Fraud Medicare Medicare COVID-19 274

Healthcare Dive

JULY 28, 2023

A data breach earlier this year has affected tens of millions of individuals to date, and also compromised the sensitive personal and medical information of Medicare seniors.

Medicare 246

Medicare Medicare 246

Healthcare Dive

AUGUST 24, 2023

The crackdown comes after media reports found fraudulent activity in hospice facilities, including those that certified patients for care who were not terminally ill and those that ran “churn and burn” Medicare billing schemes.

Medicare 246

Medicare Medicare 246

Healthcare Dive

OCTOBER 4, 2024

A handful of plans owned by the nation's largest MA payer are the latest to ask the court to help raise their valuable quality scores.

Medicare 293

Medicare Medicare 293

Healthcare Dive

OCTOBER 21, 2024

UnitedHealth, CVS and Humana used technology to increase MA prior authorization denials for post-acute services, boosting profits, according to a report from a Senate subcommittee.

Medicare 290

Medicare Medicare 290

Fierce Healthcare

SEPTEMBER 27, 2024

Many counties do not have medication for opioid use disorder (MOUD) services available through providers and treatment programs, and even in counties that do, Medicare and Medicaid beneficiaries of | A new report from HHS OIG looked at access to medication for opioid use disorder services and found many high need counties do not have specialized providers. (..)

Medicaid 129

Medicaid Medicaid Medicare Medicare 129

Fierce Healthcare

AUGUST 27, 2024

A decade ago, federal officials drafted a plan to discourage Medicare Advantage health insurers from overcharging the government by billions of dollars—only to abruptly back off amid an “uproar” fr | Filings and testimonies in a multibillion-dollar Justice Department civil fraud case against UnitedHealth Group outline industry pressure that led the (..)

Medicare 132

Medicare Medicare Fraud Governance 132

Fierce Healthcare

SEPTEMBER 30, 2024

As the calendar turns to October, the health insurance industry is gearing up for Medicare's annual enrollment period. | As the calendar turns to October, the health insurance industry is gearing up for Medicare's annual enrollment period.

Medicare 128

Medicare Medicare Health Insurance 128

Fierce Healthcare

SEPTEMBER 6, 2024

In its comments to the Centers for Medicare and Medicaid Services (CMS) on the draft CY2025 Medicare physician fee schedule (PFS), the American Medical Association badgered CMS on its pro | The American Medical Association submitted its comment letter to CMS on its draft CY2025 Medicare physician fee schedule.

Medicare 132

Medicare Medicare Doctors Medicaid 132

Becker's Health IT

SEPTEMBER 9, 2024

CMS notifies nearly a million Medicare beneficiaries of data breach involving hacker copying patient files. Software vulnerability left data exposed.

Medicare 120

Medicare Medicare 120