Medicare Advantage
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CMS issues final 2027 Medicare Advantage and Part D Payment Rates
Payor and provider groups are saying the rate increases may not be enough to stave off cuts to coverage.
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Medicare Advantage risk-coding dispute ends in $117.7m Aetna settlement
Insurer agreed to resolve US allegations that inaccurate diagnosis data for plan members inflated risk-adjusted payments from federal Medicare program.
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Elevance Health faces sanctions over data submission compliance
CMS alleges that the health insurance giant repeatedly provided risk adjustment data via unapproved external flash drives.
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CMS proposes flat rates for 2027 Medicare Advantage to ensure ‘sustainability’
The agency is also proposing a shift in the risk-adjustment model traditionally used in the MA program.
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DOJ secures record-breaking $6.8 billion in False Claims Act settlements, judgments for FY 2025
The healthcare fraud category took the lion’s share with a staggering $5.7 billion in recovered funds from FCA matters.
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DOJ announces $556m settlement with Affiliates of Kaiser Permanente
The settlement resolves allegations that the healthcare consortium was pressuring its physicians to alter medical records to support increased reimbursement rates.