How a Utah woman claims she became a victim of Medicare fraud
Willard, Box Elder County – An Anatomy Enthusiast’s Medicare Frustration Linda Carlinsey describes herself as an anatomist, a title that seems fancy but really just means she enjoys puzzles. What she doesn’t enjoy, however, are the unexpected charges that recently showed up on her Medicare account. “It really makes me mad,” Carlinsey expressed. “There’s no […]
Medicare test program to utilize AI for pre-approving medical procedures
Medicare Pilot Program Utilizing AI for Procedure Approvals The new Medicare pilot program will necessitate prior approval for specific medical procedures where AI will determine compensation eligibility. Updated: 6:39pm EDT August 29th, 2025 The Centers for Medicare and Medicaid Services (CMS) is introducing programs that require prior approval from insurers for certain medical procedures. The […]
Medicare to test an AI program for approving medical procedures in advance
Medicare Pilot Program Implementing AI for Medical Procedure Approvals A new Medicare pilot program mandates prior approval for certain medical procedures using artificial intelligence to determine reimbursement eligibility. This initiative is set to roll out in several states next year. New initiatives from the Centers for Medicare and Medicaid Services (CMS) will require some medical […]
Medicare trial program will utilize AI for approving medical procedures in advance
Medicare Pilot Program Utilizing AI for Medical Procedure Approvals This new Medicare Pilot program will mandate prior approval for specific medical procedures, leveraging AI to determine compensation eligibility. Recent initiatives from the Centers for Medicare and Medicaid Services (CMS) require insurance companies to grant prior approval for certain medical procedures. The government plans to assess […]
Maryland market risks driving more Medicare Advantage plans out of the state
Potential Changes to Medicare Advantage Plans in Maryland Major insurance companies are contemplating the discontinuation of Medicare Advantage plans next year, which will leave many retirees in Maryland without their existing healthcare options. About 25% of Maryland’s Medicare recipients currently rely on supplemental Medicare care programs. These programs assist low-income retirees in accessing private insurance […]
Medicare will mandate additional prior authorization in certain states.
Changes to Medicare Pre-Approval Requirements Residents in Washington and five other states enrolled in traditional Medicare will soon need to seek pre-approval for specific health services. This is somewhat reminiscent of the hurdles faced with commercial insurance plans, but it’s an unusual step for traditional Medicare. The Centers for Medicare & Medicaid Services have announced […]
UnitedHealth’s Ongoing Criminal Investigation Is Wider Than Medicare
U.S. Investigates UnitedHealth Group’s Prescription Management Services The criminal division of the U.S. Department of Justice is probing UnitedHealth Group Inc.’s prescription management services, specifically how the company reimburses doctors, according to sources familiar with the situation. This area of inquiry, previously unreported, suggests that the investigation is broader than just potential Medicare fraud. Besides […]
Ongoing Struggles in Medicare Advantage Plans
Changes Ahead for Medicare Advantage Plans The Medicare Advantage Plan is undergoing significant changes, and more updates are expected in 2026. In 2024, we observed various factors contributing to increased costs and reduced benefits within the 2025 Advantage Plan. During a three-year period, the Centers for Medicare and Medicaid Services (CMS) reduced payments for the […]
CVS Caremark to pay $290M following Medicare fraud scheme revealed by ex-Aetna whistleblower
CVS Health’s Caremark Ordered to Pay $290 Million Over Medicare Overcharges A federal court has directed Caremark, the pharmacy benefits manager for CVS Health, to pay nearly $290 million due to allegations of overcharging Medicare for prescription drugs a decade ago. This came after Sarah Behnke, a former actuary at Aetna, accused Caremark of defrauding […]
CVS Health Ordered to Pay Almost $290M for Medicare Fraud
A federal judge has ordered CVS Health’s Caremark division to pay approximately $290 million after determining that the company overcharged Medicare for prescription drugs. Philadelphia’s Supreme Court Justice Mitchell Goldberg raised the initial damages from $95 million to about $285 million, adding a civil penalty of $4.87 million under the False Claims Act. Healthcare companies […]