Unusually high rates of prior authorization denials
The Department of Health and Human Services’ inspector general’s latest report found three specific Medicare Advantage plans had the highest
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DHS -OIG
Coding abuses and Medicare Advantage Payment
The U.S. Department of Health and Human Services Office of Inspector General’s new report found Medicare may have overpaid Medicare
Read MoreCMS may have improperly paid $2.26M for virtual services: Audit
(By: Elizabeth Casolo for Becker’s Hospital Review) HHS’ Office of Inspector General found CMS may have improperly paid more than
Read MoreNew Industry Segment-Specific Voluntary Compliance Program Guidance
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) has released the new industry Segment-Specific Voluntary
Read MorePrivate Medicare, Medicaid Plans Exaggerate In-Network Mental Health Options, Watchdogs Say
(By Tony Leys for KFF Health News) Companies running private Medicare and Medicaid insurance plans inaccurately list many mental health
Read MoreNursing homes fail to report 43% of most serious falls: HHS
(By: Elizabeth Gregerson for Becker’s Hospital Review) Nursing homes failed to report 43% of falls that resulted in major injury
Read MoreBilling for Remote Patient Monitoring in Medicare
In 2024, Medicare paid $536 million for remote patient monitoring, a 31 percent increase from 2023. Remote patient monitoring (RPM)
Read MoreMore Medicare patients leaving hospitals against medical advice
(By: Paige Twenter for Becker’s Hospital Review) The rate of Medicare enrollees leaving acute care hospitals against medical advice increased 46%
Read MorePrior Authorization Process Policies in Medicaid Managed Care: Findings from a Survey of State Medicaid Programs
(By Jada Raphael, Elizabeth Hinton, Aimee Lashbrook, and Kathleen Gifford for The Kaiser Family Foundation Published: Aug 07, 2025) Medicaid
Read MoreMedicare Part B Drug Payments: Impact of Price Substitutions Based on 2023 Average Sales Prices
(Source – oig.hhs.gov) Medicare Part B annually spends billions of dollars to cover a limited number of outpatient prescription drugs.
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