Tag: Medicare Advantage
In brief: MA fraud, Abbott settlement, MiniMed separation, SoClean commercial
September 16, 2026HME News Staff
WASHINGTON – The Office of Inspector General (OIG) says it has identified gaps in the screening process for fraudulent DMEPOS suppliers in Medicare Advantage.
The agency issued a report on Sept. 9 saying Medicare Advantage organizations (MAOs) conduct some screening checks on in-network suppliers but fewer checks of out-of-network suppliers. It also says:
The Centers for Medicare & Medicaid Services (CMS) does not screen all DEMPOS suppliers before they bill Medicare Advantage because...
OIG to CMS: ‘Medicare Advantage is also at risk’
September 14, 2026HME News Staff
WASHINGTON – The Office of Inspector General (OIG) says it has identified gaps in the screening process for fraudulent DMEPOS suppliers in Medicare Advantage.
The agency issued a report on Sept. 9 saying Medicare Advantage organizations (MAOs) conduct some screening checks on in-network suppliers but fewer checks of out-of-network suppliers. It also says:
The Centers for Medicare & Medicaid Services (CMS) does not screen all DEMPOS suppliers before they bill Medicare Advantage because...
CMS adds 11 medical supply companies to Preclusion List
September 9, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has identified and is barring 11 medical supply companies with more than $3.4 billion in suspected fraudulent billing practices in 2025 and 2026 from receiving future Medicare Advantage (MA) Part C and Part D payments.
According to the agency, these 11 durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers:
Had submitted no claims prior to 2025
Used improper billing practices for their claims
Had...
Prior authorization metrics provide new insight, KFF says
August 18, 2026HME News Staff
WASHINGTON – Medicare Advantage insurers denied 13% of standard prior authorization requests, Medicaid managed care insurers denied 14% and ACA Marketplace insurers denied 18%, according to a new analysis from KFF.
Insurers were required to post the first year of prior authorization metrics for the 2025 calendar year by March 31, 2026. KFF collected and analyzed these metrics from the largest insurers in most market segments for which reporting is required.
Other key takeaways from the...
MedPAC: Medicare Advantage now reaches 55% of eligible beneficiaries
July 20, 2026HME News Staff
WASHINGTON – The Medicare Payment Advisory Committee (MedPAC) has released its 2026 data book on health care spending and the Medicare program. The publication provides data on spending, demographics, beneficiary access, quality of care and other information. Data include:
Medicare spent $1 trillion on personal health care in 2024, representing 23% of national spending on personal health care. Medicare covered 16% of people in the U.S.
In February 2026, enrollment in MA plans, which...
Bill seeks to eliminate prior authorization for wheelchair repairs
June 25, 2026HME News Staff
WASHINGTON – Rep. Ayanna Pressley, D-Mass., has introduced legislation that would remove prior authorization requirements from Medicare Advantage plans for maintenance and repairs to wheelchairs and other complex rehab technology (CRT).
“When a wheelchair breaks down, daily life is disrupted,” said Pressley. “I’m grateful to my constituents and our disability justice advocates for informing this vital legislation.”
Pressley announced the “Facilitating...
AAHomecare throws weight behind Medicare Advantage reforms
June 19, 2026HME News Staff
WASHINGTON – AAHomecare has sent letters of support to the sponsors of legislation in the House and Senate that would reform Medicare Advantage prior authorization, claims integrity and transparency.
In its letters to Rep. John Joyce, R-Pa., and Sen. Roger Marshall, R-Kan., the organization shared how the bills would address challenges that home medical equipment (HME) providers face daily and would improve access to medical necessary equipment for Medicare beneficiaries.
“These...
In brief: Dems drop MA bill, Soleo launches new brand, VGM partners with HME360
April 24, 2026HME News Staff
WASHINGTON — Reps. Pramila Jayapal, D-Wash., and Ro Khanna, D. Calif., have introduced the Stop Deadly Denials Act to no longer allow Medicare Advantage plans to require prior authorization for necessary medical items and services.
The legislation would ensure patients are able to receive fair affordable coverage without added administrative burdens from prior authorization that frequently block care.
“Medicare DisAdvantage makes it harder for patients to get the care they need...
Dems introduce bill to eliminate prior auths for MA plans
April 23, 2026HME News Staff
WASHINGTON — Reps. Pramila Jayapal, D-Wash., and Ro Khanna, D. Calif., have introduced the Stop Deadly Denials Act to no longer allow Medicare Advantage plans to require prior authorization for necessary medical items and services.
The legislation would ensure patients are able to receive fair affordable coverage without added administrative burdens from prior authorization that frequently block care.
“Medicare DisAdvantage makes it harder for patients to get the care they need...
In brief: CMS ups MA payments, Sleep Cycle sees interest, Soleo Health expands
April 10, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has set a net average increase of 2.48% for Medicare Advantage plans in calendar year 2027, representing more than $13 billion in additional payments.
Earlier this year, CMS had proposed a net average increase of 0.09%, representing $700 million in additional payments.
CMS touts improved payment accuracy
In a new rate announcement, the agency says this expected increase includes consideration of the various elements that...