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HHS cut 3M ACA Marketplace enrollments in ongoing fraud efforts
2+ mon, 2+ week ago (453+ words) A new HHS report contends the Trump Administration has rooted out nearly 3 million fraudulent Affordable Care Act Marketplace enrollments. Still, the agency estimates there are 2.6 million "improper or phantom enrollments" remaining on the Marketplace. The report, prepared by the HHS…...
OIG calls on states to tamp down Medicaid provider fraud
1+ mon, 2+ week ago (652+ words) Flavijus Piliponis â stock.ado The HHS Office of Inspector General wants states to ensure stronger contractual obligations with Medicaid managed care organizations to flag Medicaid provider fraud, the agency wrote in a recent report. Specifically, OIG called for CMS…...
CMS locks in 2%+ payment bumps for SNFs, post-acute care providers
1+ mon, 1+ week ago (999+ words) The Centers for Medicare and Medicaid Services has finalized its payment updates to key post-acute care providers and inpatient psychiatric facilities. Skilled nursing facilities, inpatient rehabilitation facilities, hospices and IPFs all received a Medicare payment bump to their respective prospective…...
Medical supply companies banned in $3.4B fraud takedown
4+ day, 20+ hour ago (393+ words) The CMS has banned 11 medical supply companies from billing Medicare Advantage and Part D, including four that had already been barred from Traditional Medicare, after identifying more than $3.4 billion in alleged fraudulent billing practices over the last two years. The…...
AdaptHealth says hackers exfiltrated patient data in social engineering attack
2+ mon, 4+ day ago (254+ words) Vitalii Gulenok/istock via Getty AdaptHealth, a nationwide supplier of home medical equipment, disclosed a data breach that impacted an undetermined number of patients, according to a Form 8-K filing with the U.S. Securities and Exchange Commission. The company partners with…...
CMS fraud war room stops $203M in debated Medicaid payments
1+ mon, 2+ week ago (682+ words) The Centers for Medicare and Medicaid Services is already lauding a new Medicaid fraud effort to be successful in its first 90 days after identifying more than $203 million in potentially improper payments to the federal program. The Medicaid Fraud War Room…...
CMS proposes expanded authority to revoke Medicare privileges
2+ mon, 1+ week ago (904+ words) The Trump administration wants to double down on its healthcare fraud, waste and abuse crackdown. This time, policymakers are seeking to expand CMS' powers to remove providers from Medicare -- a move that the agency says will save taxpayers about $82 million…...
Appeals court overturns No Surprises Act QPA calculation method
4+ week, 2+ day ago (657+ words) In a major win for healthcare providers, a U.S. appeals court ruled against the federal government's formula for calculating qualifying payment amounts under the No Surprises Act. The ruling released on Tuesday tossed aside two key factors insurers use to determine…...
ACA premiums set to surge 14% as tax credits expire
2+ mon, 5+ day ago (810+ words) AndreyPopov/istock via Getty Ima Payers participating in the ACA Marketplace have proposed a median premium increase of 14% for 2027 -- the second-highest rate hike since 2018 -- as the expiration of enhanced premium tax credits reshapes their risk pools and leaves millions without…...
Physician pay cuts loom as CMS unveils major Medicare reforms
1+ mon, 4+ week ago (1084+ words) Christian Delbert - stock.adobe. The Centers for Medicare & Medicaid Services has released the proposed rule for the Medicare Physician Fee Schedule for the 2027 calendar year, which federal leaders say contains some of the most significant Medicare reforms in years. The…...