Medicare - Health Care Compliance Brief

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

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

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

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

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

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

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

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 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 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

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

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

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

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

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

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

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

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

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

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

Congress finally eliminates Part D vaccine cost sharing: Medicare coverage is still broken

Healthcare Dive

AUGUST 26, 2022

The Inflation Reduction Act leaves intact a peculiar split in Medicare vaccine coverage that discourages physicians from offering certain vaccines, argues former Moderna Vice President Richard Hughes.

Medicare

Medicare Medicare

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 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

AHA urges DOJ to probe Medicare Advantage plans that deny care

Healthcare Dive

MAY 23, 2022

The hospital lobby is pushing the Justice Department to go beyond the recommendations in a new report from the HHS OIG and punish Medicare Advantage organizations that routinely deny coverage to beneficiaries.

Medicare

Medicare Medicare Hospitals

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

Hospitals charge employer health plans more than 2 times what they charge Medicare for same services

Healthcare Dive

MAY 18, 2022

Florida, West Virginia and South Carolina had relative prices at or above 310% of Medicare prices, according to the report. Rand researchers also found wide price variations across states.

Medicare

Medicare Medicare Hospitals

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

Supreme Court rules in favor of HHS in Medicare disproportionate share payments case

Healthcare Dive

JUNE 27, 2022

The highest court upheld HHS' method of calculating Medicare payments to hospitals serving a high proportion of low-income patients, rebutting hospitals’ efforts to recoup potentially billions of dollars from the program.

Medicare

Medicare Medicare Hospitals

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

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

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

Cigna sells Medicare businesses to HCSC for $3.7B

Healthcare Dive

JANUARY 31, 2024

With the deal, Cigna is exiting a sector that’s been a huge source of growth for insurers but has seen its earnings potential shrink.

Medicare

Medicare Medicare

Medicare Advantage profitability is declining, Moody’s says

Healthcare Dive

JANUARY 30, 2024

Insurers' MA earnings were 2% lower in 2022 than in 2019, signaling profits in the lucrative insurance program may be weakening.

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

Insurers brace for continued Medicare Advantage medical costs

Healthcare Dive

FEBRUARY 20, 2024

The big question coming out of the health insurance earnings season is how much elevated utilization among seniors will carry over into 2024.

Medicare

Medicare Medicare Health Insurance

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

Medicare Advantage star ratings fall again in 2025

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

Medicare Medicare

Humana sued over alleged 340B underpayments in Medicare Advantage

Healthcare Dive

FEBRUARY 13, 2024

Alabama-based Baptist Health argued the insurer had received a “windfall” due to illegal payment cuts in the 340B drug discount program.

Medicare

Medicare Medicare

ACOs led by independent physicians save Medicare ‘substantially’ more money, CBO says

Healthcare Dive

APRIL 17, 2024

Independent practices have clearer financial incentives to lower medical spending than hospitals participating in accountable care organizations, according to the Congressional Budget Office.

Medicare

Medicare Medicare Hospitals

CVS slashes 2024 outlook — again — as Medicare seniors drive spending

Healthcare Dive

MAY 1, 2024

Runaway inpatient spending in particular caused CVS’ insurance costs to snowball after returning “to patterns we have not seen since the start of the pandemic,” its CFO said.

Medicare

Medicare Medicare

Physicians, hospitals decry 2025 Medicare payment rates

Amazon expands drug subscription program to Medicare members

Trending Sources

Humana inks minority investment in Medicare choice tool Healthpilot

Medicare to cover Novo’s obesity drug for some patients

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

Remote patient monitoring in Medicare needs more oversight: OIG

Medicare go-broke date pushed back to 2031

Cigna is still interested in Medicare

Semaglutide coverage for weight loss could cost Medicare billions: study

Medicare Advantage beneficiaries receive fewer home health visits, study finds

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

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

Humana sues HHS over Medicare Advantage audits

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

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

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

Government watchdog warns of Medicare fraud after relaxing provider requirements

Insurer lobby blames government policies for 2025 Medicare Advantage market makeup

Senate Finance Committee tackles Medicare physician pay reform

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

OIG report suggests telehealth fraud rare in Medicare

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

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

Congress finally eliminates Part D vaccine cost sharing: Medicare coverage is still broken

Medicare to collect drug price rebates starting in 2025

CMS recalculates Medicare Advantage stars for UnitedHealth, Centene

AHA urges DOJ to probe Medicare Advantage plans that deny care

Medicare saves record $2.1 billion from largest accountable care program

Hospitals charge employer health plans more than 2 times what they charge Medicare for same services

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

Supreme Court rules in favor of HHS in Medicare disproportionate share payments case

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

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

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

Cigna sells Medicare businesses to HCSC for $3.7B

Medicare Advantage profitability is declining, Moody’s says

Medicare reveals results of drug price negotiations

Insurers brace for continued Medicare Advantage medical costs

Medicare Advantage prior authorization denials increased in 2022: KFF

Medicare finalizes higher 2.9% inpatient payment rate for 2025

Medicare Advantage star ratings fall again in 2025

Humana sued over alleged 340B underpayments in Medicare Advantage

ACOs led by independent physicians save Medicare ‘substantially’ more money, CBO says

CVS slashes 2024 outlook — again — as Medicare seniors drive spending

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