The investigation has triggered bipartisan concern, with lawmakers scrutinizing whether risk adjustment practices have crossed ethical lines. The move signals a shift from passive oversight to active enforcement, putting the future of MA funding and the industry's credibility at a tipping point.

For healthcare providers, prior authorization represents an additional layer of administrative complexity. They must familiarize themselves with specific requirements, gather supporting documentation,…

Medicare Advantage Organizations (MAOs) - including health plans, IPAs, MSOs, and risk-bearing providers are grappling with a wave of unprecedented challenges. The implementation of CMS’s Hierarchical Condition Category (HCC) risk adjustment model Version 28 (V28) is already reshaping the industry.

Healthcare organizations today are continuously seeking opportunities to lift margins in the midst of increasing financial challenges. NewCare IPA is one example of an independent physician organization…