Social Media Ideas for Medicare Advantage Risk Adjustment

The Villages Health System $541.5 Million Settlement: A New Frontier in Medicare Advantage Risk Adjustment Enforcement

Four Is A Trend: Lessons For Medicare Advantage Diagnosis Coding Programs To Take From Recent FCA Settlements

Second Largest Medicare Advantage FCA Settlement of All Time

The Villages Health System LLC, a Florida-based provider deeply integrated with the retirement community of the same name, has agreed to pay $541.5 million to resolve False Claims...

Audit Readiness is Decided Months Before the First Chart Request Arrives

The following is a guest article by Michael Egbert, Chief Executive Officer at Sherpas Healthcare Solutions CMS has scaled Risk Adjustment Data Validation (RADV) to a degree the in...

Alignment Healthcare sues CMS over its 2027 Medicare Advantage star ratings

Alignment Healthcare sued federal regulators, alleging that its 2027 Medicare Advantage star ratings were determined "in flagrant violation" of statute.

As MA Denial Rates Rise, Hospitals Are Betting on Traditional Medicare Instead

As Medicare Advantage denial rates climb, health systems are dropping plans and steering patients back to traditional Medicare. Pearl Health CEO Michael Kopko thinks the original M...

How Medicare Advantage prior authorization delays care

Medicare Advantage has become one of the most important parts of the American health care system. Designed as a privately administered alternative to traditional Medicare, the prog...

Modernizing Medicare Advantage for the Next Generation of Seniors

The Centers for Medicare & Medicaid Services (CMS) took constructive steps in its 2027 final rule and rate announcement, particularly on payment integrity and quality measureme...

Can AI in risk adjustment be trusted to code accurately?

Health care’s relationship with artificial intelligence (AI) often swings between two extremes: enthusiasm and anxiety. On one hand, AI is helping clinicians reduce administrative...

34 Million People Are Expected to Be in Medicare Advantage in 2027 — Check Whether Your Plan Is Changing

Millions of Americans rely on Medicare Advantage for their healthcare coverage, but having a plan that worked well in 2026 doesn’t guarantee the same benefits...

When “Paying Correctly” Means Paying Nothing: How to Make Medicare Advantage Accountable

By FRANK LEAHY This is the second of two pieces. The first told the story of “Rick,” a 77-year-old Humana Medicare Advantage member who nearly lost his sight in a months-long runar...

Medicare Advantage health costs rise 9.6% as plan margins narrow

Benchmark data shows admin discipline held but benefit cost growth is the variable that moved

CMS Says Medicare Advantage Premiums Are Expected to Drop 16.5% in 2027 — Check What Your Plan Will Cost

A 16.5% drop in Medicare Advantage premiums sounds like welcome news for retirees watching every dollar, but don’t start adjusting your 2027 budget based on...

Independence Blue Cross to pay $22.5M in Medicare Advantage inaccurate diagnoses allegations settlement

The settlement resolves allegations from 2017 to 2021 that the company submitted “inaccurate and untruthful” diagnoses data to CMS.

CMS projects Medicare Advantage premiums to decline by 16% in 2027

The Trump administration is projecting significant declines in premiums for Medicare Advantage plans in 2027.

HealthMetrix Research Selects 2027 Medicare Advantage Plans for Exceptional Benefit Value & Overall Performance

Humana, Devoted Health, Aetna, Alignment Health

The Villages Health Agrees to Pay $542M for Medicare Advantage Overbilling

The Villages Health System in central Florida, part of the world’s largest retirement community, has agreed to pay almost $542 million to settle civil claims stemming from its disc...

Medicare Advantage or Original Medicare? Start With These 7 Questions

This article contains affiliate links. If you use these links to connect with a Medicare advisor or enroll in coverage, Saving Advice may earn a...

Focus on HMOs, C-SNPs: A look at the Medicare Advantage landscape for 2027

With Medicare's annual enrollment period on the horizon, major insurers are offering a look at their plans for the coming year and new federal data offers a broader look at the cur...

CMS: About 71% of MAPD plan enrollees in coverage with four or more stars for 2027

The Trump administration has released the 2027 Medicare Advantage star ratings, with many enrollees in plans that earned at least four stars.

Five Ways Health Systems are Responding to the Medicare Supplemental Phase Out

Medicare Advantage Drug Coverage Is Changing for 2027 — 8 Medications Worth Checking Before You Enroll

Your Medicare Advantage plan covered your prescriptions throughout 2026, so you might assume the same medications will cost roughly the same next year. Unfortunately, that...

More than 3 million Medicare Advantage enrollees need to find new plans for 2027 in third year of turmoil

By Tami Luhby, CNN (CNN) — Fewer health insurance plans. Higher out-of-pocket costs. Skimpier supplemental benefits. This upheaval is what senior citizens will have to contend with...

HMSA revamping Medicare Advantage plans

Hawaii’s largest health insurer is overhauling its Medicare Advantage plans for 2027 due to financial challenges.