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Medicare Advantage

Latest Headlines

Latest Headlines

Following $450 million settlement, DaVita subpoenaed for Medicare Advantage coding

Nearly two months after DaVita Healthcare announced it would pay nearly half a billion dollars to settle claims that it improperly billed Medicare for wasted vials of medication, the largest dialysis provider in the country is facing a subpoena from the U.S. Department of Health and Human Services (HHS), according to a Securities Exchange Commission (SEC) filing released by the company on Wednesday.

How Premera Blue Cross broke into the Medicare Advantage market [Q&A]

Humana and UnitedHealth dominate the fast-growing Medicare Advantage market across the country. But Washington-based Premera Blue Cross proved that insurers can challenge the top dogs. Although...

Number of Medicare Advantage plans with $0 premium on decline

The number of Medicare Advantage plans with a $0 premium dropped from 813 in 2014 to 726 in 2015, according to a recent HealthPocket survey. 

New estimates say Medicare Advantage inflated risk scores cost $2 billion a year

Medicare Advantage plans could have a problem with risk scores that are manipulated by insurers to get a higher reimbursement, according to a  Bloomberg Business  article. Experts says inflated risk scores cost Medicare $2 billion in 2014. 

Government audit reveals UnitedHealth Group Medicare Advantage plan overbilling

A government audit obtained by the Center for Public Integrity revealed claims that UnitedHealth Group, the nation's largest Medicare Advantage provider, overbilled the government $381,776 in a small sample of cases. UH appealed the decision and denounced the audit--a three-year secret legal battle ensued. 

Humana deal will benefit payers at expense of providers

The  health insurance industry consolidation that a Humana sale would bring stands to benefit payers while challenging hospitals and providers.

How BCBS is transforming its payment model

Blue Cross and Blue Shield companies understand that transforming the healthcare reimbursement system depends not just on cutting costs but, rather, reinventing how doctors and providers are paid.

Second senator calls for Medicare Advantage oversight

A week after Sen. Chuck Grassley (R-Iowa) called on the Department of Justice and the Centers for Medicare & Medicaid Services to investigate fraud and abuse within Medicare Advantage plans, another senator from the other side of the aisle reaffirmed the need for improved federal scrutiny.

Court: UPMC to maintain Highmark's Medicare Advantage in-network rates

A ruling by Pennsylvania Commonwealth Court Judge Dan Pellegrini mandates that the University of Pittsburgh Medical Center maintain in-network rates until 2019 for Highmark's Medicare Advantage members.

ACA to add $274B in admin costs to healthcare system through 2022

The Affordable Care Act will add hundreds of billions of dollars in administrative costs to the nation's healthcare system through 2022. Private insurers will bear the brunt of this overhead.