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Latest News & Web Pages
Favorable OIG Advisory Opinion Underscores Ongoing Scrutiny of Ancillary Service Referrals
3+ hour, 7+ min ago (352+ words) The US Department of Health and Human Services Office of Inspector General (OIG) recently issued Advisory Opinion No. 26-02, concluding that a proposed arrangement under which an urgent care management entity would operate an affiliated clinical laboratory would not generate prohibited…...
Governor sends letter to HHS requesting changes to Medicare Advantage rates
8+ hour, 7+ min ago (231+ words) Gov. Jenniffer Gonz'lez Col'n sent a letter this week to U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. in response to the notice of methodological changes for calendar year 2027 to Medicare Advantage capitation rates and payment policies for Parts…...
To avoid care disruptions, know when the clock runs out on your prior authorization
9+ hour, 30+ min ago (1169+ words) A woman with multiple sclerosis wanted to be able to walk up the stairs at home without losing her balance. Her doctor prescribed medicine that helped, but then approval from her insurance plan for the drug expired. Jaclyn Mayo has…...
$3 million NIH grant funds national study of Medicare Advantage’s benefit expansion into social supports
17+ hour, 54+ min ago (277+ words) A $3 million National Institute on Aging grant will fund a national study of Medicare Advantage's benefit expansion into social supports such as food assistance, transportation, and other non-medical benefits." Led by George Mason University health economist Jeah Jung, the five-year…...
Kaiser’s $556 Million Medicare Advantage FCA Settlement: Implications for Providers and Plan Disputes
18+ hour, 42+ min ago (627+ words) Key Takeaways - DOJ's $556 million settlement with Kaiser Permanente shows intensified False Claims Act enforcement in Medicare Advantage risk-adjustment coding. Federal regulators continue to prioritize alleged upcoding and unsupported diagnosis submissions under Medicare Part C....By: Arnall Golden Gregory LLP Kaiser's $556 Million…...
How Medicare Advantage Soaks Taxpayers — and Retirees
19+ hour, 34+ min ago (583+ words) With private insurers set to receive $1.2 trillion in excess payments by 2036, retirees may soon face a reckoning over costs and coverage. Sent five days a week Kiplinger A Step Ahead Sent twice a week Sent weekly for six weeks Kiplinger…...
Proposed Part D Payment Model Falls Short
22+ hour, 33+ min ago (305+ words) Join Us Live for a Discussion on Medicare, Democracy, and the Future of Health Care This week, the Medicare Rights Center commented on a proposal from the Centers for Medicare and Medicaid Services (CMS) to test a prescription drug payment…...
CMS Proposes to Reduce Medicare Advantage Overpayment, Plans Still Profitable
22+ hour, 34+ min ago (497+ words) Join Us Live for a Discussion on Medicare, Democracy, and the Future of Health Care This week, Medicare Rights submitted comments in response to the 2027 Advance Notice from the Centers for Medicare & Medicaid Services (CMS). The Advance Notice is an…...
Insurance groups say proposed flat Medicare Advantage rates fail to meet the moment
22+ hour, 36+ min ago (773+ words) The Trump administration has proposed flat rates in Medicare Advantage (MA) for 2027, and insurers argue in new commentary that those levels do not reflect the realities of the program. In late January, the Centers for Medicare & Medicaid Services (CMS) released…...
Are Medicare Advantage Plans Bad for People with Cancer?
23+ hour, 18+ min ago (21+ words) Are Medicare Advantage Plans Bad for People with Cancer?Breast Cancer.org Are Medicare Advantage Plans Bad for People with Cancer?...