Explore 2025 managed care enforcement trends under the Trump administration. Learn about Department of Justice (DOJ) and ...

On January 14, the Department of Justice (DOJ) announced that five Kaiser Permanente affiliates agreed to pay $556 million to ...

A Senate report accuses UnitedHealth Group of turning Medicare Advantage risk adjustments into a profit strategy.

By Sneha S K Jan 12 (Reuters) - Health insurer UnitedHealth Group used aggressive risk-adjustment coding tactics to increase ...

The Biden administration is proposing to increase Medicare Advantage (MA) and Part D plan payments by 1.03% for 2024 amid other changes to the programs’ risk adjustment model. The Centers for Medicare ...

The probe began after STAT and others reported on UnitedHealth's strategies to boost profits in Medicare Advantage.

Faced with new government regulations, Medicare Advantage (MA) organizations should be utilizing technology to increase the accuracy of their coding, mitigate their risk, and ensure appropriate care ...

Kaiser Permanente (Kaiser) has agreed to pay $556 million to resolve False Claims Act litigation alleging improper Medicare Advantage risk-adjustment practices, according to the U.S. Department of ...

The Alliance of Community Health Plans is calling out risk adjustment scores by larger insurers in Medicare Advantage plans. ACHP, an organization that advocates for smaller health plans, said the ...

LEWES, Del., April 22, 2025 (GLOBE NEWSWIRE) -- John Snow Labs, the AI for healthcare company, today announced its new end-to-end Hierarchical Condition Category (HCC) coding engine designed to help ...

George Witwer, CEO of Cavo Health Outperforms Machine Learning Tools with 96%+ HCC completeness, 2–4x Productivity Gains and Reduced Audit Risk Our platform delivers more accurate, audit-ready results ...