Medicare - Health Care Compliance Brief

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

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

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

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 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

Medicare go-broke date pushed back to 2031

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

Medicare Medicare Hospitals

Lobby-funded study argues Medicare Advantage rate cuts are worse than CMS expects

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

Medicare Medicare

Medicare ACO participation grows in 2024: CMS

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

Medicare Medicare Governance

Medicare Advantage rate cut remains as feds keep up pressure

Fierce Healthcare

APRIL 1, 2024

Insurers will feel resentful Monday as the feds opted to not reverse its decision to decrease Medicare Advantage benchmark payments by 0.16%, the Centers for Medicare and Medicaid announced. | CMS is not deviating from its January proposal to modestly rein in Medicare Advantage.

Medicare

Medicare Medicare Medicaid Medicaid

Medicare Advantage overpayments could exceed $75B this year, study finds

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.

Overpayments

Overpayments Overpayment Medicare Medicare

Telehealth services during pandemic largely compliant with Medicare, OIG finds

Healthcare Dive

FEBRUARY 16, 2024

The latest audit from HHS’ Office of Inspector General comes as some Medicare flexibilities for telehealth are set to expire at the end of this year.

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

Understanding Medicare Training

American Medical Compliance

APRIL 17, 2024

The following Understanding Medicare Training educates healthcare providers and patients on the purpose of the Medicare program in the United States. Medicare is the federal health insurance program for people aged 65 or older, certain younger people with disabilities, and also people with End-Stage Renal disease.

Medicare

Medicare Medicare Compliance Health Insurance

Medicare to collect drug price rebates starting in 2025

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

Medicare Medicare

CMS threatens to cut hospices from Medicare if they can’t prove legitimacy

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

Medicare Medicare

Government watchdog warns of Medicare fraud after relaxing provider requirements

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

Fraud Governance Medicare Medicare

Medicare Advantage seniors have better health outcomes, study finds

Healthcare Dive

NOVEMBER 9, 2023

New research from Harvard and Inovalon found MA beneficiaries had fewer hospital readmissions, fewer preventable hospitalizations and lower rates of high-risk medication use than those in traditional Medicare.

Health Outcomes

Health Outcomes Medicare Medicare Hospitals

CMS final rule on broker comp, health equity could shake up Medicare Advantage

Fierce Healthcare

APRIL 5, 2024

Centers for Medicare & Medicaid Services finalized a host of actions ranging from broker compensation, health equity, mental health, supplemental benefits and biosimiliars, in the Contract Year | Medicare Advantage plans will need to adjust to new star ratings requirements, industry watchers warned following a final rule on Thursday.

Medicare

Medicare Medicare Medicaid Medicaid

CMS says data of 612K Medicare beneficiaries affected in MoveIt breach

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

Medicare Medicare

KFF: A look at healthcare spending trends in Medicare households

Fierce Healthcare

MARCH 15, 2024

Medicare households are spending far more on healthcare than other households, according to a new KFF analysis. Medicare households are spending far more on healthcare than other households, according to a new KFF analysis.

Medicare

Medicare Medicare

Medicare Enrollment & Behavioral Health Credentialing

MedTrainer

APRIL 18, 2024

Behavioral health credentialing exploded in 2023 and 2024 as providers could enroll in Medicare for the first time. Download Now Common Challenges in Behavioral Health Credentialing Where behavioral health credentialing diverges from typical provider credentialing is Medicare enrollment.

Medicare

Medicare Medicare Licensing Compliance

OIG report suggests telehealth fraud rare in Medicare

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

Fraud Medicare Medicare COVID-19

Walgreens to accept Medicare Advantage OTC benefits online

Fierce Healthcare

FEBRUARY 28, 2024

Walgreens will now accept a slew of Medicare Advantage supplemental benefits online, including the option for home delivery, the company announced this week. Walgreens will now accept a slew of Medicare Advantage supplemental benefits online, including the option for home delivery, the company announced this week.

Medicare

Medicare Medicare

CMS seeks input on improving transparency in Medicare Advantage

Fierce Healthcare

JANUARY 25, 2024

The Centers for Medicare & Medicaid Services is seeking feedback on how to increase transparency around Medicare Advantage and improve data capabilities. |

Medicare

Medicare Medicare Medicaid Medicaid

Medicare Advantage beats traditional Medicare in important categories: report

Fierce Healthcare

JUNE 28, 2023

Medicare Advantage (MA) beneficiaries have fewer inpatient hospital stays and emergency department visits than beneficiaries in traditional fee-for-service Medicare, according to a

Medicare

Medicare Medicare Hospitals

CMS caps broker payments in Medicare Advantage

Healthcare Dive

APRIL 8, 2024

The final rule issued Thursday prevents insurers from paying brokers additional fees for steering beneficiaries to their plans.

Medicare

Medicare Medicare

Chartis: A look at Medicare Advantage enrollment trends in 2024

Fierce Healthcare

MARCH 4, 2024

Medicare Advantage (MA) growth has broadly slowed, but the biggest players in this space continue to claim the lion's share of this expansion, according to a new report from healthcare consultant C | Medicare Advantage growth has broadly slowed, but the biggest players in this space continue to claim the lion's share of this expansion, according (..)

Medicare

Medicare Medicare

Hackers claim to obtain CVS, Medicare data in Change hack

Becker's Health IT

APRIL 8, 2024

Hacking group claims to have stolen 4TB of data, including information on insurers like CVS Caremark and Medicare, in cyberattack on Change Healthcare.

Medicare

Medicare Medicare

Medicare Advantage analysis sparks infighting at MedPAC meeting

Fierce Healthcare

JANUARY 12, 2024

A MedPAC meeting on the status of Medicare Advantage held Friday began with numbers on enrollment and insights into coding diagnoses, before devolving into contentious debate over the quality of th | Spirited disagreement arose during MedPAC's Medicare Advantage sessions on Friday, as members debated the merits of the program.

Medicare

Medicare Medicare

Medicare Advantage Bait and Switch

HealthIT Answers

OCTOBER 14, 2023

That’s why, 19 months from now, when I turn 65, I’m going to sign up for traditional Medicare. The post Medicare Advantage Bait and Switch appeared first on Health IT Answers. The only exception is anything really stupid that could kill me or you or both of us at the same time.

Medicare

Medicare Medicare

HHS: Medicare incentives, penalties for hospitals could help stem drug shortages

Fierce Healthcare

APRIL 3, 2024

To address the nation’s drug shortages, the Department of Health and Human Services (HHS) is floating a plan that would attach new Medicare payments and penalties to hospitals’ supply chain practic | A white paper penned by HHS outlines a potential program that would push hospitals toward inventory and purchasing practices that reinforce long-term (..)

Medicare

Medicare Medicare Hospitals

Brightside Health expanding Medicare and Medicaid telemental health access

Healthcare IT News - Telehealth

FEBRUARY 22, 2024

Brightside Health will be entering into new and expanded payer partnerships to support telemental healthcare access through Medicare and Medicaid, teaming with companies such as Blue Shield of California, CareOregon and Centene.

Medicaid

Medicaid Medicaid Medicare Medicare

Experts offer Medicare Advantage quality bonus program recommendations

Fierce Healthcare

MARCH 5, 2024

A new-look Medicare Advantage (MA) quality bonus program would better incentivize insurers and help individuals choose a more appropriate plan, a report from Urban Institute finds. | A new report looks at how the Medicare Advantage quality bonus program could be improved, including taking the star ratings reporting private.

Medicare

Medicare Medicare

Payers up against slight decline in 2025 Medicare Advantage payments

Fierce Healthcare

JANUARY 31, 2024

Medicare Advantage (MA) payments are set to decrease yet again in 2025 as the feds phase in significant changes to risk adjustment. Medicare Advantage payments are set to decrease yet again in 2025 as the feds phase in significant changes to risk adjustment.

Medicare

Medicare Medicare

Medicare Advantage marketing practices draw ire from senators

Fierce Healthcare

OCTOBER 18, 2023

Seniors are forced to navigate a convoluted Medicare Advantage (MA) landscape for healthcare coverage, often only to be denied care, experts told legislators during a Senate Finance Committee heari | Senators and experts agreed Wednesday that marketing practices from Medicare Advantage plans are often overwhelming for seniors.

Medicare

Medicare Medicare

HLTH23: Experts debate the flaws, future of Medicare Advantage

Fierce Healthcare

OCTOBER 9, 2023

LAS VEGAS—Medicare Advantage (MA) has only grown over the last decade, and, in tandem, voices criticizing the program have gotten louder. | LAS VEGAS—Medicare Advantage has only grown over the last decade, and, in tandem, voices criticizing the program have gotten louder.

Medicare

Medicare Medicare

MedPAC report slammed by insurers and docs over Medicare Advantage and physician reimbursement

Fierce Healthcare

MARCH 15, 2024

Providers objected to its proposal to give physician reimbursement relief, while plans disagreed with its attitude toward Medicare Advantage. Health plans and providers alike are disgruntled with a new report (PDF) to Congress released | It seems everyone was left unsatisfied by MedPAC's newest report to Congress.

Medicare

Medicare Medicare

Cigna inks deal to sell Medicare business to HCSC for $3.7B

Fierce Healthcare

JANUARY 31, 2024

Cigna will sell off its Medicare business to Health Care Service Corporation in a deal valued at $3.7 HCSC will acquire Cigna's Medicare Advantage, Part D, supplemental benefits and CareAllies businesses, and the parties expect the deal to close in the first quarter of 2025. billion, the company announced Wednesday.

Medicare

Medicare Medicare

Cigna explores selling Medicare Advantage business: report

Fierce Healthcare

NOVEMBER 6, 2023

Cigna is looking into the possibility of selling its Medicare Advantage (MA) business, according to a report from Reuters. Cigna may decide to sell off its Medicare Advantage business. The insurer is reportedly in early discussions with an investment bank to go over its options.

Medicare

Medicare Medicare

Discount drug company Waltz Health moves into Medicare market

Mobi Health News

FEBRUARY 23, 2024

The company will offer a customizable version of its Marketplace Search Technology to health plans supporting Medicare beneficiaries.

Medicare

Medicare Medicare

Moody's: Why Medicare Advantage's profitability may be on the decline

Fierce Healthcare

JANUARY 29, 2024

Medicare Advantage (MA) continues to grow, but there are signs that its profitability is on the decline, according to a new report from Moody's Investors Service. Medicare Advantage continues to grow, but there are signs that its profitability is on the decline, according to a new report from Moody's Investors Service.

Medicare

Medicare Medicare

Important Resources to Ensure Medicare Compliance

Compliancy Group

MARCH 22, 2024

depend on Medicare to get the healthcare they need. Remaining in good standing with Medicare has several advantages. Compliance Program A comprehensive way to avoid Medicare exclusion is to develop an organization-wide compliance program, one of the Centers for Medicare and Medicaid Services (CMS) requirements.

Medicare

Medicare Medicare Compliance Compliance Officers

Medicare paid out $31.2B in improper payments for FY23, CMS says

Fierce Healthcare

NOVEMBER 20, 2023

Traditional Medicare paid out an estimated $31.2 The Centers for Medicare & Medicaid Services released its annual look at improper payments and found that the overall rate in Medicare was 7.38%, which sits below the 10% level mandated in statute.

Medicare

Medicare Medicare Medicaid Medicaid

Medicare to cover Novo’s obesity drug for some patients

Cigna is still interested in Medicare

Trending Sources

Medicare Advantage beneficiaries receive fewer home health visits, study finds

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

Humana sues HHS over Medicare Advantage audits

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

Medicare go-broke date pushed back to 2031

Lobby-funded study argues Medicare Advantage rate cuts are worse than CMS expects

Medicare ACO participation grows in 2024: CMS

Medicare Advantage rate cut remains as feds keep up pressure

Medicare Advantage overpayments could exceed $75B this year, study finds

Telehealth services during pandemic largely compliant with Medicare, OIG finds

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

Understanding Medicare Training

Medicare to collect drug price rebates starting in 2025

CMS threatens to cut hospices from Medicare if they can’t prove legitimacy

Government watchdog warns of Medicare fraud after relaxing provider requirements

Medicare Advantage seniors have better health outcomes, study finds

CMS final rule on broker comp, health equity could shake up Medicare Advantage

CMS says data of 612K Medicare beneficiaries affected in MoveIt breach

KFF: A look at healthcare spending trends in Medicare households

Medicare Enrollment & Behavioral Health Credentialing

OIG report suggests telehealth fraud rare in Medicare

Walgreens to accept Medicare Advantage OTC benefits online

CMS seeks input on improving transparency in Medicare Advantage

Medicare Advantage beats traditional Medicare in important categories: report

CMS caps broker payments in Medicare Advantage

Chartis: A look at Medicare Advantage enrollment trends in 2024

Hackers claim to obtain CVS, Medicare data in Change hack

Medicare Advantage analysis sparks infighting at MedPAC meeting

Medicare Advantage Bait and Switch

HHS: Medicare incentives, penalties for hospitals could help stem drug shortages

Brightside Health expanding Medicare and Medicaid telemental health access

Experts offer Medicare Advantage quality bonus program recommendations

Payers up against slight decline in 2025 Medicare Advantage payments

Medicare Advantage marketing practices draw ire from senators

HLTH23: Experts debate the flaws, future of Medicare Advantage

MedPAC report slammed by insurers and docs over Medicare Advantage and physician reimbursement

Cigna inks deal to sell Medicare business to HCSC for $3.7B

Cigna explores selling Medicare Advantage business: report

Discount drug company Waltz Health moves into Medicare market

Moody's: Why Medicare Advantage's profitability may be on the decline

Important Resources to Ensure Medicare Compliance

Medicare paid out $31.2B in improper payments for FY23, CMS says

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