CMS is suspending enrollment for a Maryland Medicare Advantage institutional special needs plan operated by Provider Partners Health Plans after the insurer lost all contracted long-term care facilities in the plan’s network and then disenrolled some members without their consent.…
Medicare Advantage
The HHS Office of the Inspector General estimates $462 million in CMS overpayments to Medicare Advantage plans stemming from some unsupported acute stroke diagnosis codes. In a May report, the OIG reviewed a sample of 97 MA beneficiaries. The entire…
Elevance Health has cleared an initial hurdle to avoid CMS enrollment and communications sanctions over some of its Medicare Advantage plans — but still faces two deadlines. In February, CMS alleged that Elevance had submitted data corrections for unsupported diagnosis…
Insurers are facing a June 1 deadline to submit their 2027 Medicare Advantage bids to the federal government, including their benefits. In recent years, MA plans have been under pressure amid rising medical costs and utilization. While the federal government…
A new Medicare Advantage advocacy organization has emerged with the backing of several major health systems, adding more provider voices to the increasingly crowded debate over the future of the public-private program. The Alliance for Medicare announced its launch this…
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A federal judge has sided with the Justice Department in its bid to depose a former senior executive at Elevance Health over allegations that the insurer submitted fraudulent Medicare Advantage claims to the government. On May 20, the judge ordered…
President Donald Trump’s portfolio managers traded seven health insurers’ stocks as 2027 Medicare Advantage payment policies were being ironed out. The U.S. Office of Government Ethics released disclosures in May laying out thousands of trades in the first three months…
Medicare beneficiaries enrolled in Part D plans offered by vertically integrated insurers paid lower monthly premiums but higher out-of-pocket drug costs compared to enrollees in other plans, according to a May 19 analysis from the HHS Office of Inspector General. …
CarolinaEast Medical Center, a 350-bed hospital in New Bern, N.C., will drop Blue Cross Blue Shield and UnitedHealthcare Medicare Advantage plans, effective July 1, citing burdensome payment policies, claim denials and reimbursement delays. The hospital issued termination notices to both…
A departing senior Elevance Health executive is pushing back against demands from the Justice Department to depose him in a Medicare Advantage fraud lawsuit against the insurer that stretches back several years. On May 6, Elevance asked a New York…