The report calls for improved oversight of MA and urges the CMS to update audit protocols and issue new guidance on medical necessity reviews performed by the plans.| Healthcare Dive
Trade association AHIP said it was “concerned with the potential adverse impact of the rate notice,” especially in light of other recent regulation seeking to claw back overpayments to MA payers.| Healthcare Dive
The record payment comes on the heels of another massive settlement for the nonprofit, adding to the hit on its already stressed bottom line.| Healthcare Dive
"We should be addressing this in a more serious fashion than we are," Sen. Bill Cassidy, R-La., said.| Healthcare Dive
The insurer paid vendors to conduct in-home visits with its members, then pressured the vendors to record high-value diagnoses that would lead to higher payments for Cigna, the DOJ alleges.| Healthcare Dive
Attempts to "defraud the program cannot continue and will be pursued," DOJ officials said in statement announcing the action against the California-based system.| Healthcare Dive
The figure is almost triple prior estimates, highlighting the need for payment reform to avoid overtaxing the Medicare system, researchers said.| Healthcare Dive
“Insurers are in effect denying Americans necessary care in order to fatten and pad their bottom lines, and that phenomenon is unacceptable,” Sen. Richard Blumenthal, D-Conn., said at a subcommittee hearing.| Healthcare Dive
Risk adjustment changes will now be phased in over three years, after payers pushed back on the proposed payment rule.| Healthcare Dive
Federal regulators have raised concerns about alleged payment abuses in the MA program for years, specifically for those tied to risk adjustments.| Healthcare Dive
The payer, which brings in the bulk of its revenue from Medicare, is fighting a rule finalized earlier this year to claw back overpayments in the increasingly popular MA program.| Healthcare Dive
Enrollment in MA plans has steadily increased since 2007, when one in five Medicare beneficiaries were enrolled in a private plan.| Healthcare Dive
Both hospital and payer groups came out in support of the rule finalized Wednesday, finding common ground in the need to streamline prior authorization.| Healthcare Dive