Aetna has agreed to pay $117.7 million to resolve allegations that it violated the False Claims Act by submitting or failing to withdraw inaccurate diagnosis codes for its Medicare Advantage enrollees in order to increase payments from CMS. The settlement…
Medicare Advantage
Elevance said it was “surprised and disappointed” by a recent CMS sanction threat, which would suspend enrollment in Medicare Advantage prescription drug plans, CFO Mark Kaye said March 10 at the Barclays 28th Annual Global Healthcare Conference in Miami. The…
The Office of the Inspector General for HHS found 121,454 emergency department procedures were possibly billed incorrectly in 2021 and 2022, leading to over $15.1 million in improper or potentially improper payments. Medicare improperly paid physicians $922,524 and may have…
The Congressional Joint Economic Committee identified an additional $13.4 billion contributing to higher Medicare Part B premiums in 2025 due to Medicare Advantage overpayments, according to a March 10 report. The committee relied on Medicare Payment Advisory Commission estimates. Overpayments…
Following the annual enrollment period for 2026, 56.1 million people — up from 54.6 million in 2025 — are enrolled in Medicare Part D, which includes standalone prescription drug plans and Medicare Advantage plans with prescription drug coverage, as of…
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Medicare beneficiaries had about 60 million telehealth visits per year between 2021 and 2023, according to a February study published in Annals of Internal Medicine. Co-author and University of Utah assistant professor Terrence Liu, MD, broke down the findings March…
CMS reported a record of nearly 47,000 comments on its Medicare Advantage payment proposal for 2027. The insurer-backed Better Medicare Alliance, an MA advocacy group, hosted an executive summit March 3, featuring CMS Director of Medicare and Deputy Administrator Chris…
Network Health, a Wisconsin-based insurer owned by Froedtert ThedaCare Health, grew 37% during this past annual enrollment period to 126,000 total Medicare Advantage members, its second consecutive year of record growth. The plan also posted a 98% member retention rate.…
Medicare Advantage enrollment grew less than 1% during this past annual enrollment period, but beneath that modest topline number was a dramatic reshuffling as national payers shed hundreds of thousands of members while smaller and regional plans posted some of…
The insurer-backed Better Medicare Alliance, a Medicare Advantage advocacy group, and over 100 other organizations sent a letter Feb. 27 to CMS Administrator Mehmet Oz, MD, urging the agency to modify proposed 2027 rate levels for Medicare Advantage. The signatories…