Justice Department investigating Humana billing practices
By
John Hall
Feb 24, 2015
Humana Inc. reports that it is cooperating with a Department of Justice inquiry into whether it exaggerated the severity of elderly patients’ illnesses to generate higher Medicare reimbursements.
Lawmakers pushing CMS to ease Medicare Advantage prior authorizations
By
Kimberly Marselas
Jun 26, 2023
Close to 300 members of Congress are urging federal regulators to do more to reduce burdensome Medicare Advantage requirements that can slow delivery of care to nursing home and other patients.
House committee subpoenas HHS over Medicare Advantage demonstration project
By
McKnight's Staff
Oct 23, 2012
Rep. Darrell Issa (R-CA) and other House Republicans issued a subpoena Monday to gain access to documents related to an Affordable Care Act Medicare Advantage demonstration project.
As Medicare Advantage grows, experts say, so do hard-to-fight denials
By
Kimberly Marselas
May 19, 2022
In addition to sagging Medicare Advantage payment rates, some skilled nursing providers also find themselves routinely doing battle to get paid for services they’ve already delivered.
CMS eyes 8% revenue increase for Medicare Advantage
By
Danielle Brown
Feb 04, 2022
The Centers for Medicare & Medicaid Services is forecasting a nearly 8% increase in revenue for Medicare Advantage plans next year. The agency released its 2023 advance notice earlier this week.
Group wants feds to probe Medicare Advantage plans wrongly denying care
By
Danielle Brown
May 25, 2022
An influential group of healthcare providers is calling on the Department of Justice to investigate Medicare Advantage organizations that have been found wrongly denying services to beneficiaries.
Providers warned not to interfere with resident healthcare coverage choices after $8 million settlement
By
Danielle Brown
Jul 13, 2022
The nation’s largest nursing home association is urging providers to properly educate staff on acceptable practices when it comes to discussing changes to residents’ healthcare coverage in order to...
Disenrolling residents from MA plans leads to $7.85 million provider settlement with feds
By
Danielle Brown
Jul 01, 2022
A New York-based provider is settling allegations that it switched resident’s Medicare coverage to maximize its reimbursements for nearly $8 million.
How often do health insurers say no to patients? No one knows.
By
Robin Fields/ProPublica
Jun 29, 2023
It’s one of the most crucial questions people have when deciding which health plan to choose: If my doctor orders a test or treatment, will my insurer refuse to pay for it?
Long-term care leaders cheer proposed Medicare Advantage appeals rule in final push
By
Josh Henreckson
Jan 08, 2024
A surge of public and professional support arrived Friday as the comment period closed for a proposed federal rule that providers say could level the playing field with Medicare Advantage plans.