Social Media Ideas for Medicare Secondary Payer Act Recovery Actions

The Sixth Circuit Revives the Medicare Waiver of Liability for Overpayments and Appeals

CMS's Revised Medicare Overpayment Rule: What Healthcare Providers Need to Know

Here Are the 5 Steps That Got Me Nearly $7,000 Back From Medicare

Even a CPA can get blindsided by Medicare's income penalty. But here's the good news: one little-known form is clawing back nearly $7,000 for me.

Complete Health Partners Holdings $14M FCA Settlement: Medicare Advantage Risk-Adjustment Fraud

Complete Health Partners Holdings, a Jacksonville-based management services organization overseeing affiliated provider groups in Florida, Alabama, and Colorado, has agreed to pay...

How to Respond to a Notice of Medicare Non-Coverage (NOMNC)

If you’re receiving care through a skilled nursing facility, home health agency, or outpatient rehabilitation center, there may come a day when your provider hands you a form title...

Ohio payers lose a year of recovery reach

SB 162 halves the clawback lookback and bars fees on provider appeals

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...

More Than a Billing Requirement: CMS Turns Medicare Enrollment into a Program-Integrity Tool

Key Updates CMS has proposed a significant expansion of its Medicare provider enrollment and program-integrity authorities through the Calendar Year 2027 Home Health Prospective P...

New York City and Insurer to pay $53 million after retirees successfully challenged Medicare copays

One of the largest class-action payouts in city history lands as insurers wrestle with a wave of litigation over Medicare Advantage and retiree health costs

Compliance Program Lessons from the Complete Health Settlement

On August 4, 2026, the United States Department of Justice (“DOJ”) on behalf of the Office of Inspector General (“OIG”) of the U.S. Department of Health and Human Services announce...

Complete Health to pay $14.1M in Medicare Advantage coding misuse allegations settlement

The settlement resolves allegations from 2020 to 2023 that the company submitted HCCs that were "not clinically valid" or not supported by medical records or treatment plans.

New York City and insurer to pay $53 million after retirees successfully challenged Medicare copays

One of the largest class-action payouts in city history lands as insurers wrestle with a wave of litigation over Medicare Advantage and retiree health costs

FQHCs - The Expanding Landscape of Medicare Billing Outside of PPS for Care Management Services

Summary: Medicare has steadily expanded the services that Federally Qualified Health Centers can bill outside the Prospective Payment System, creating new reimbursement opportunit...

Medicare to Increase Payments for Inpatient Rehabilitation Facilities in FY 2027

The Centers for Medicare & Medicaid Services (CMS) has published a final rule updating payment rates for inpatient rehabilitation facilities (IRFs) under Medicare for federal.....

CMS releases FY 2027 IPPS final rule

Crushing and Flexing: CMS Proposes to Expand Its Discretion to Deny and Revoke Medicare Enrollment

ANOTHER MISS: Medicare Health Advisors Loses Summary Judgment Bid As Court Rejects “Hearsay” Jornaya Record After Defens...

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...

The Remote Monitoring Reckoning: What CMS’s CY 2027 Proposed Rule Means for Providers and Vendors

Medicare’s reimbursement of remote patient monitoring services, beginning in 2019, offered a meaningful patient care opportunity, paying to give patients devices to measure their h...

A Partnership-driven Approach to Waste and Abuse Prevention

[Sponsored] Discover how payers can shift from costly post-payment recovery to intentional prevention through data-driven oversight, accountability, and partnership. The post A Par...

Medicare’s Hidden Two-Year Lookback Rule Can Catch Retirees by Surprise

The medicare two-year lookback rule means your 2024 income sets your 2026 premiums. The post Medicare’s Hidden Two-Year Lookback Rule Can Catch Retirees by Surprise appeared first...

DOJ’s $6.5B Medicaid sweep raises stakes on ‘honest mistakes’

On June 23, the U.S. Department of Justice announced it had charged 455 defendants, including 90 physicians and other licensed health care professionals, with more than $6.5 billio...

A Federal Crackdown on Health Care Fraud Is Here: What Providers Need to Know Right Now

A Closer Look at Medicare Part D Penalty Details That Can Raise Costs for Years

Missing your Medicare Part D enrollment deadline might not seem like a big deal, especially if you don’t take any prescription medications. But that decision...