Medicare Medicaid Category

Medicare & Medicaid

News articles in this section include actions by federal regulators like the CMS and HHS, as well as information on Medicare and state Medicaid coverage and benefits.

CMS Confirms Medicare Advantage Quality Ratings To Get New Calculations

The Centers for Medicare & Medicaid Services (CMS) will rework Medicare Advantage (MA) quality ratings for this year. Private insurers will treat the decision as good news, as some health plans could receive “hundreds of millions in additional payments,” The Wall Street Journal first reported June 13. SCAN Health Plan and Elevance Health recently took CMS to court over a ...

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California Will Refund More Than $52 Million To Federal Government For Immigrant Care

California needs to repay more than $52 million to the federal government after improperly claiming reimbursement from the Medicaid program for some immigrant patients, according to a recently released report from federal inspectors.

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Medicare Advantage Plan Sellers Fight CMS Agent Pay Cap In Court

Medicare Advantage plan brokers and distributors are asking the federal courts to give them immediate protection against new Centers for Medicare and Medicaid Services agent compensation rules. The plaintiffs predict in three separate suits that plan distribution channels will break down if the courts fail to block the agent comp rules for the 2025 coverage ...

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Biden Plan to Save Medicare Patients Money on Drugs Risks Empty Shelves, Pharmacists Say

Months into a new Biden administration policy intended to lower drug costs for Medicare patients, independent pharmacists say they’re struggling to afford to keep some prescription drugs in stock. “It would not matter if the governor himself walked in and said, ‘I need to get this prescription filled,’” said Clint Hopkins, a pharmacist and co-owner ...

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Cyberattacks, Medicare Changes Hang Over Health Insurers’ Meeting

America’s Health Insurance Plans is meeting in Las Vegas this week, and everything has changed. A year ago, the health insurers that belong to AHIP were focusing on efforts to expand and improve Medicare plan operations. UnitedHealth was excited about its newly acquired Change Healthcare health data services unit. This year, the Centers for Medicare ...

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Blue Shield of California Warns Consumers About Medicare Scams and Fraudsters

It’s important to be on the lookout for scams every day of the year, but during Medicare Fraud Prevention Week June 3-9, Blue Shield of California warns its Medicare beneficiaries about scammers who want their personal, financial, and health plan information. Healthcare fraud in the U.S. is an enormous, expensive problem — costing up to $300 billion, according to the National Health Care Anti-Fraud Association. ...

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CVS Warns It Could Lose Up To 10% Of Its Medicare Members Next Year

Facing the wrath of upset investors following its first quarter earnings, CVS Health has promised to value margins over members going forward. First apologizing for last quarter’s earnings, which were plagued by higher-than-expected Medicare Advantage (MA) utilization, CFO Thomas Cowhey told the Bank of America Securities 2024 Health Care Conference crowd that CVS remains a big ...

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Medicare Advantage Two-Midnight Rule Contributing To Higher Outpatient Revenues

More than 20% of Medicare Advantage patients could be affected by the rule, report finds.

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Medicare Advantage Risk Assessments Driving Billions In Costs Each Year

Medicare Advantage plans have come under fire for upcoding that can increase the payouts they receive, and regulators point to health risk assessments as a likely culprit in this increase in coding intensity.

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RAND: Hospitals Charged Insurers 254% More Than Medicare Rates In 2022

The gap between insurance plans and Medicare's payments to hospitals for inpatient and outpatient services widened over the course of just a couple of years, a new study from RAND Corporation finds.

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