Medicare Advantage

Appeals court reverses Florida ruling, finding FCA whistleblowers are not US officers and may continue bringing fraud claims on behalf of the government.

DOJ is increasing enforcement on Medicare Advantage upcoding as recent settlements reveal widespread issues with unsupported diagnoses and inflated payments.

Agreement resolves allegations that the system provider submitted unsupported diagnosis codes to Medicare Advantage plans.

Warehouse giant partners with Scan Health Plan to offer Medicare Advantage and supplemental plans, extending its growing footprint in low‑cost healthcare services.

Compliance, regulatory fairness, and $115m in bonus payments are at the heart of why insurer Elevance Health says it is taking CMS to court.

Of the 15 bills considered in the legislative markup session, several related to price transparency, access to care, and prior authorization reform.

A potentially $50 billion proposal to cap traditional Medicare out-of-pocket costs would trigger serious compliance and operational changes across CMS, Medigap, and Medicare Advantage.

Two reports examined prior authorization practices at the three largest Medicare Advantage Organizations across acute care, rehabilitation, and nursing facilities.