Court dismisses Humana’s lawsuit over Medicare Advantage star ratings
Diving briefs: A federal judge dismissed a lawsuit from Humana against the federal government aimed at improving its Medicare Advantage Star rating, marking a significant setback for insurance companies. Humana had sued CMS in October 2024, seeking to reverse the quality score and argued that the agency had acted arbitrarily to downgrade the rating in […]
Medicare focuses on equal treatment across locations and clear pricing in hospital outpatient regulations.
Medicare Outpatient Services Proposed Changes Under a new proposed rule, hospitals may receive an additional $8 billion in Medicare rebates for outpatient services next year, with a projected rate increase of 2.4%. However, the American Hospital Association expresses dissatisfaction, calling the proposed pay raise insufficient. They have criticized the measures aimed at creating more equitable […]
Pharmacy owner in New Jersey confesses to cheating Medicare and Medicaid out of $175K
Pharmacy Owner Pleads Guilty to Health Care Fraud The proprietor of a specialty pharmacy in Linden has confessed to orchestrating a scheme that defrauded Medicare and Medicaid out of more than $175,000. Thomas Conzo, 49, from Staten Island, New York, entered a guilty plea related to health care fraud, as confirmed by officials from the […]
CMS suggests a new rule to adjust Medicare doctor payments with the ‘Big Beautiful Bill’ and MACRA
Draft Payment Updates The proposed adjustment to the conversion factor is quite significant—three times more generous for APM-certified physicians at 0.75%, compared to just 0.25% for those not involved in this model. Interestingly, the Physician Association has expressed support for this approach. They believe it recognizes the higher indirect costs faced by office-based physicians when […]
100,000 Americans receiving new Medicare cards for a significant reason: ‘Great importance’
Medicare Recipients Get New Cards After Data Breach More than 100,000 Medicare beneficiaries will receive new cards and numbers due to what has been labeled as “data incidents” by their representatives. The Centers for Medicare and Medicaid Services (CMS) mentioned that they have discovered “suspicious activities” related to the fraudulent creation of Medicare accounts. This […]
Medicare data leak reveals private information of more than 100,000 individuals in the U.S.
Medicare Data Breach Affects Over 100,000 Americans Healthcare data seems to be a prime target for cybercriminals. Just in June, there were two significant breaches that compromised over 13 million patient records. Recently, it was confirmed that a new Medicare data breach has directly impacted more than 100,000 people in the U.S. The Centers for […]
Medicare publishes new hospital ratings
Hospital Ratings in Missouri Ozark, Missouri – Recent assessments rate hospitals across 46 regions based on various performance metrics, from treatment of heart attacks and pneumonia to readmission rates. Mercy Hospital Springfield scored 3 out of 5 stars. The hospital exceeded expectations regarding outpatient return visits post-surgery. However, it has fallen short of the national […]
Former UnitedHealth doctors questioned by DOJ in Medicare fraud investigation, report says
A recent report indicates that a prominent health insurance provider is under scrutiny for allegedly encouraging its staff to make certain diagnoses to secure higher Medicare reimbursements. This concern has been developing since last summer and involves claims that staff were prompted to document Medicare benefits that would result in higher payments linked to programs […]
The Villages Health files for bankruptcy due to mistaken Medicare billing.
Village Health Files for Bankruptcy Amid Medicare Dispute Village Health has entered bankruptcy after it was discovered that they owe hundreds of millions to the federal government due to fraudulent Medicare claims. Founded nearly 15 years ago, the organization has faced significant challenges related to its Medicare claims practices, which have led to this legal […]
Medicare and Medicaid Services experiences a data breach
The Centers for Medicare & Medicaid Services (CMS) is informing Medicare beneficiaries that their personal information might be involved in a data incident impacting their Medicare.gov accounts. The CMS utilized information obtained from unknown external sources to detect unusual activities linked to the fraudulent creation of certain online beneficiary accounts. They are treating this matter […]