Medicare Advantage
Expert articles and analysis related to medicare advantage.
AI Summary — Last 7 Days
CMS is tightening operational and financial scrutiny of Medicare Advantage while still preserving rate growth: the Trump administration finalized a 2.48% MA payment increase for 2027, even as CMS recalculates 2026 Star Ratings after the Clover Health litigation and pressures plans over risk-adjustment billing, including Elevance Health’s $342M payment amid a CMS probe and enrollment-sanction threat (KFF Health News). The week’s pattern is a sharper MA accountability cycle—overpayment controls, Star Ratings volatility, and prior-authorization/access concerns in oncology and post-acute care—raising contract and revenue-risk exposure for payers, delegated provider groups, and VBC organizations that depend on MA benchmarks, quality bonuses, and risk coding integrity (Fierce Healthcare
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MedPAC’s Narrow Lens on Medicare Advantage Is Incomplete  American Hospital Association
1. Medicare Advantage Company Pays $342M to Government in Midst of Billing Probe
From newsletter: Morning Briefing: Friday, June 26, 2026 Morning Briefing: Friday, June 26, 2026 Elevance Health pays CMS more than $342M amid Medicare probe; school vaccine mandates in Florida; what ...
Medicare Advantage Company Pays $342M to Government in Midst of Billing Probe
The payment by Elevance Health to the Centers for Medicare & Medicaid Services comes as the agency threatened to bar new enrollments in the company’s plans.
95% Of Appealed Medicare Advantage Skilled Nursing Facility Denials Were Reversed - open minds
95% Of Appealed Medicare Advantage Skilled Nursing Facility Denials Were Reversed  open minds
Brown scholar offers Congress actionable solutions for Medicare Advantage overpayment issues
Brown scholar offers Congress actionable solutions for Medicare Advantage overpayment issues  Brown University
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Ethics, Risk Adjustment, and a Turning Point for Medicare Advantage – ICD10monitor  MedLearn Publishing
Elevance pays CMS $342M in midst of Medicare Advantage probe
Elevance pays CMS $342M in midst of Medicare Advantage probe  Modern Healthcare News