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 […]
Court invalidates regulation restricting broker fees in Medicare Advantage
Diving briefs: A federal judge has overturned rules from the Biden administration aimed at limiting payments to agents and brokers involved with the Medicare Advantage Plan. On Monday, Judge Reed O’Connor of the Northern District of Texas ruled that the CMS had overstepped its authority by attempting to restrict contracts that would reduce payments to […]
Anticipated Changes in Medicare Part D Policies and Premiums for Next Year
Medicare Part D Premiums Expected to Rise in 2026 While final figures aren’t available yet, it’s anticipated that Medicare Part D Prescription Drug Insurance premiums will see noticeable increases in 2026. Part D Insurance is provided by private companies and is overseen by the Centers for Medicare and Medicaid Services (CMS). This program has been […]
Trump’s tax law may lead to nearly $500 billion in Medicare reductions over the next ten years unless corrected, according to CBO.
Recent analysis from the Congressional Budget Office suggests that Medicare spending is set for significant cuts in the next decade, following the passage of President Trump’s major tax laws last month—and this might happen without any action from Congress. Nonpartisan budget analysts calculated that substantial overall cuts to the federal program could be triggered as […]
Certain retirees in Connecticut express concerns about Medicare Advantage and advocate for alternatives.
Medicare Advantage’s Challenges Faced by Connecticut Retirees Medicare Advantage, a private plan versus traditional Medicare managed by the federal government, has faced criticism in recent years for allegedly denying or delaying care for senior citizens. James Russell, a former sociology professor, and Gloria Bent, the widow of a physicist, share a common experience. Both are […]
Pilot program raises Democratic worries about Medicare regulations
House Democrats are urging more transparency regarding what they term the new demonstrations from the Department of Health and Human Services (HHS), particularly concerning the introduction of pre-authorization requirements for Medicare. A collective of 17 Democrats, led by Susan Delbene (D-Wash.) and Ami Bera (D-Calif.), are questioning HHS’s motives behind the proposed pre-authorization for traditional […]