An external audit of the insurers in-home assessment program for Medicare Advantage seniors found nearly all diagnoses made during visits were supported by medical records.
Kevin Kinsella
A Peterson-KFF analysis shows ACA premiums climbing in 2027 due to rising medical costs, inflation, higher utilization, and shifts in the marketplace risk pool.
Healthcare organizations might think the delay in HIPAA changes will buy them time before having to deal with compliance issues, but legal and data security experts advise against putting them off.
The panel, which typically convenes three times per year to review scientific evidence on preventive screenings and treatments, has not met in person since March 2025.
Federal antitrust suit claims two pharmacy benefits managers worked together to suppress pharmacy reimbursements rates, fueling ongoing scrutiny of PBM practices.
The PNF froze €46m in the corruption and money laundering investigation, underscoring the risks at play when healthcare compliance meets private equity.
Compliance, regulatory fairness, and $115m in bonus payments are at the heart of why insurer Elevance Health says it is taking CMS to court.
With the ACCESS Model, CMS aims to modernize Medicare payment, expand tech supported care, and reward measurable outcomes.