Support for legislation to stop upcoding in Medicare Advantage
AARP has voiced its support for legislation aimed at curtailing a controversial practice affecting Medicare Advantage. This program has been under scrutiny due to providers allegedly inflating costs by misclassifying diagnoses to secure higher reimbursements. Senior advocacy groups have rallied around bipartisan measures designed to tackle this “upcoding” issue. They argue that correcting these practices […]
UnitedHealth confirms investigation by the DOJ regarding Medicare billing.
UnitedHealth Group announced on Thursday that it is currently under criminal and civil inquiries from the Department of Justice (DOJ) concerning its Medicare claims practices. In its securities filing, the healthcare company mentioned they have started to address the formal criminal and civil demands. Following this news, UnitedHealth’s shares dropped by nearly 4% on Thursday. […]
UnitedHealth acknowledges investigation by the DOJ regarding Medicare fraud
UnitedHealth Group’s shares dipped on Thursday after the company disclosed that it is under investigation by the Justice Department. The healthcare giant indicated that it is cooperating with federal agents, responding to both criminal and civil inquiries. In its filing with the Securities and Exchange Commission, UnitedHealth emphasized its history of compliant behavior and responsible […]
UnitedHealth reports it is under investigation by the DOJ regarding Medicare billing practices
UnitedHealth Group Under Investigation by DOJ UnitedHealth Group recently disclosed that it’s being investigated by the Department of Justice (DOJ) regarding its Medicare claims practices. This came to light in a securities filing where the company noted that it has begun complying with both criminal and civil requests made by the DOJ. Additionally, UnitedHealth has […]
A flawed program: Republican lawmakers consider changes to Medicare Advantage
Concerns Over Medicare Advantage Raised in Congressional Hearing During a Congressional hearing on Tuesday, several Republicans voiced criticism regarding Medicare Advantage (MA), suggesting that the privatized program might need a significant overhaul from Washington. Although calling for reforms isn’t new, it’s noteworthy when MA proponents criticize the GOP, especially since the party has historically supported […]
Significant reforms to Social Security and Medicare are necessary before it becomes too late
Recently, I took a flight from Philadelphia to Hilton Head, and there was a couple in their sixties seated behind me. I couldn’t help but eavesdrop on their chat with fellow passengers. They were raving about retirement, sharing how their pension and medical benefits from past corporate jobs now enabled them to travel freely and […]
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 […]