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New Medicare Advantage Regulations Add Provider and Beneficiary Protections Against Plan Utilization Management Policies

On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule (CMS-4201-F) regarding the Medicare Advantage (MA) and Part D programs. The Final Rule includes changes related to various aspects of...more

Supreme Court Ruling in AHA v. Becerra May Affect 340B Hospitals' Reimbursement Rights Against Medicare Advantage Plans

Hospitals that participate in the 340B program may be entitled to additional monies from Medicare Advantage plans in the wake of the Supreme Court’s decision in AHA v. Becerra. In AHA v. Becerra, a unanimous Supreme Court...more

Launches Inquiry into Medicare Advantage Marketing Practices

On August 23, 2022, Senate Finance Committee Chair Ron Wyden (D-Ore.) announced he was launching an inquiry into potentially deceptive marketing tactics by organizations offering Medicare Advantage benefits and Part D...more

Federal District Court Rules Hospital System May Sue Medicare Advantage Plan for Underpayments

On June 22, 2018, the United States District Court for the Central District of California denied Humana’s motion to dismiss a suit brought by a large nationwide hospital system, Prime Healthcare Services (Prime). In a...more

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