Category Archives: Medicare Advantage

Humana, Cigna take Hit in Medicare Advantage Star Ratings

The federal government’s release of 2017 Medicare Advantage star ratings did not bring good news for Humana and Cigna, as the major insurers earned lower quality ratings despite the overall percentage of highly rated plans remaining static. The Centers for … Continue reading

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BCBS of Tennessee Limits Participation in 2017 ACA Marketplace

CHATTANOOGA, Tenn. — BlueCross BlueShield of Tennessee has made the difficult but necessary decision to reduce our participation from eight to five regions on the Affordable Care Act (ACA) Marketplace in Tennessee for 2017. The change does not affect seniors … Continue reading

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Is the Tide Turning on Medicare Advantage Fraud Cases?

Last week’s decision by a federal appeals court to allow a whistleblower to restructure allegations against several large health insurers didn’t get a lot of mainstream media attention. Admittedly, Medicare Advantage risk scores don’t make for very sexy headlines. But the decision … Continue reading

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Aetna Rethinks its ACA Exchange Strategy

Dive Brief: Aetna on Tuesday morning announced it intends to withdraw expansion plans on the ACA markets in 2017. The announcement reverses hints from the insurer to broaden ACA market efforts which stated it “preserved…options to enter certain new geographies pending … Continue reading

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HHS Official Hints at Changes to Medicare Payment Proposal

An administration official hinted Tuesday that the White House may change pieces of its controversial proposal to alter the way Medicare reimburses providers for drugs administered by hospitals and physicians’ offices. At a heavily attended Senate Finance Committee hearing, Patrick Conway, CMS … Continue reading

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4 Forces That Will Influence Medical Cost Trends In 2017

The healthcare industry is in a transformational period. The rising use of retail clinics, MACRA, population health efforts and the Medicare Part B demonstration are but a few examples of disruptive conversations being had in board rooms. Yet, all of … Continue reading

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Taxpayers Covered $14B in Erroneous Charges by Private Health Plans

Medicare paid out $14.1 billion in improper claims in one year to private health insurance companies that bill the government for care to the elderly, but the plans have not had to pay back the money, a new report finds. The private plans, called … Continue reading

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Strengthening Medicare Advantage and Part D

Providing high quality and affordable care for all Medicare beneficiaries, with a particular emphasis on improving care for low income and dually eligible beneficiaries On April 4, CMS released final updates to the Medicare Advantage and Part D programs through … Continue reading

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Group Slapped with $6.8M HIPAA Fine

Federal HIPAA violation penalties may be capped at $1.5 million per incident per year, but there’s also state and regional fines for those disregarding privacy and security laws. Case in point, Triple-S Management Corp., a San Juan-based insurance holding company, … Continue reading

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White House Takes Aim At Medicare And Medicaid Billing Errors

White House budget director Shaun Donovan called for a “more aggressive strategy” to thwart improper government payments to doctors, hospitals and insurance companies in a previously undisclosed letter to Health and Human Services Secretary Sylvia Mathews Burwell earlier this year. … Continue reading

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