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.
CMS
Compliance, regulatory fairness, and $115m in bonus payments are at the heart of why insurer Elevance Health says it is taking CMS to court.
Medicaid work requirements face legal and compliance challenges as states warn of coverage losses, administrative burdens, and unclear federal guidance that could jeopardize vulnerable enrollees and strain safety net systems.
A Big Three health insurer says it paid the fine to head off potential Medicare Advantage sanctions as it disputes the Centers for Medicare & Medicaid Services’ finding over alleged overpayments.
Regulators are intensifying efforts to enforce information-blocking rules with potential penalties as high as $1m, in a move to increase transparency and interoperability in healthcare.
Ruling nullifies CMS’s expanded oversight of ACA eligibility, halting new verification, enrollment period, and reinstates pre-rule compliance standards for marketplaces.
A new federal rule will reshape the ACA marketplace in terms of operations and compliance while sparking significantly higher out-of-pocket costs.
The regulator described the move as part of a broader effort to modernize Medicaid oversight and strengthen the program’s long-term sustainability.