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Medicare & Medicaid
Eligibility, parts A‑D, Advantage, dual eligibility, and state program changes.
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Medicare Part D Plans Paid $562 Million for Generic Voltaren. A Doctor's Prescription Still Doesn't Make an OTC Drug Part D-Eligible
2+ hour, 6+ min ago (709+ words) A doctor's prescription cleared millions of pharmacy claims through Medicare Part D for a drug the program was never legally allowed to cover, and the bill that follows could land on beneficiaries with no warning and no open enrollment fix…...
Top Trump Official Drops Blockbuster Announcement - 'They're Going to Prison' - Federal Bust Exposes Massive Health Care Fraud
2+ hour, 26+ min ago (495+ words) A sprawling federal investigation has uncovered a nationwide threat that may have placed thousands of improperly trained workers inside hospitals, nursing homes and clinics across the United States. Although the people who allegedly built the operation are now behind bars,…...
Beyond Review Volume: What Healthcare Payers Now Expect From Managed Care and Utilization Management Consulting
10+ hour, 27+ min ago (447+ words) This shift reflects a broader change in how payers view consulting. Where engagements once focused primarily on filling gaps, many organizations now expect a consulting partner to strengthen the underlying operating model so improvements persist after the engagement ends. Why…...
Patients who fight health insurance denials often win
11+ hour, 39+ min ago (1240+ words) Few patients appeal when insurers decline to pay for their care. Many don’t even know they can. But new data show that when they do, they frequently win — in some plans, nine out of 10 times. Insurers disclosed this data on…...
His Daughter Signed the Admission Agreement as "Responsible Party," a Formality, the Nursing Home Said. When Dad's Medicaid Application Failed, the $32,000 Bill Came to Her
5+ hour, 8+ min ago (625+ words) Nursing homes hand families a stack of admission paperwork and call the signature line a formality, but a single phrase buried in that contract can transform a daughter from her father's caregiver into his creditor's target. The Full Benefits Desk…...
Dementia care can cost families thousands per month. The bills are only part of the burden.
3+ hour, 51+ min ago (888+ words) Families caring for loved ones with dementia navigate substantial costs, with memory care facilities averaging over $8,000 monthly across the U.S....
President Trump announces lower Rx prices for Medicaid | Fox News Video
15+ hour, 55+ min ago (62+ words) Fox News senior medical analyst Dr. Marc Siegel delves into the potential impact of TrumpRx and comments on health considerations from AI data centers on 'Fox Report.'... President Trump announces lower Rx prices for Medicaid Fox News senior medical analyst…...
Medicaid drug prices slashed in new program | Fox News Video
1+ day, 49+ min ago (115+ words) President Donald Trump announces lower prescription drug costs for Medicaid programs. Fox News senior medical analyst Dr. Marc Siegel analyzes how the program will save states billions and explains the impact of Trump RX. Medicaid drug prices slashed in new…...
Medicare Open Enrollment is almost here … What should I do? | Chattanooga Times Free Press
14+ hour, 49+ min ago (601+ words) This is my first Medicare Open Enrollment Period, and a few weeks ago I read your article explaining what the fall enrollment time is about. I'm still confused about what I need to do. I don't know anything about the…...
Arizona Addiction Treatment Clinic Owner Sentenced to 14 Years in Prison for Leadership Role in $69M Medicaid Fraud Scheme
3+ day, 2+ hour ago (183+ words) “Ms. Anagho’s scheme manipulated a program that was intended to help Native Americans in Arizona,” said U.S. Attorney Timothy Courchaine for the District of Arizona. “The fourteen-year sentence that she received is a sign of how serious and damaging…...