Medicare

Medicare Advantage Organizations Overturn 75% of Their Denials

By Kelly Gooch, Beckers Hospital Review. A recent investigation by the U.S. Office of Inspector General found between 2014 and 2016, Medicare Advantage organizations overturned 75 percent of their preauthorization and payment denials upon appeal. The OIG’s… Read More

DaVita Settles Huge Whistleblower Lawsuit Over Medicare Fraud

By Fred Schulte, KHN News. One of the nation’s largest dialysis providers will pay $270 million to settle a whistleblower’s allegation that it helped Medicare Advantage insurance plans cheat the government for several years. The settlement… Read More

Biggest Medicare Fraud Scheme in History

By Jay Weaver, The Miami Herald One of the state’s wealthiest healthcare operators was arrested Friday at his Miami Beach waterfront estate on charges of orchestrating the nation’s biggest Medicare fraud scheme — $1 billion…. Read More

Justice Department Joins Medicare Advantage $1B Fraud Lawsuit Against UnitedHealth

By Shelby Livingston, Modern Healthcare. The U.S. Justice Department has joined a whistle-blower lawsuit claiming that UnitedHealth Group and affiliated health plans have been gaming the Medicare program and fraudulently collecting millions of dollars by claiming… Read More

Seniors Dropping Medicare Advantage Plans

By FRED SCHULTE from Kaiser Health News. As Seniors Get Sicker, They’re More Likely To Drop Medicare Advantage Plans. A GAO report questions the quality of a number of Medicare Advantage plans after large numbers of… Read More