Medicare & Medicaid
Rebates bring down prices by as much as half.
A corrective action process would allow providers to rectify conduct without dissuading them from participating in Medicare, MGMA says.
Humana opposes the transfer to the Dallas division, DOJ says.
More than half of Medicare's 66 million beneficiaries are opting for a MA plan, which is likely to further strain the health system.
The purchase price for the transaction, net of certain tax benefits, is reduced from $510 million to approximately $425 million.
The lawsuit accuses Humana of cutting payments prematurely for rehabilitative care based on its AI model's "highly inaccurate" recovery predictions.
Of the roughly 1.1 million enrollees who have opioid use disorder, just 18% receive medication to treat it, OIG said.
The Federal IDR process is used when plans and providers cannot agree on the payment amount for out-of-network items and services.
HHS also released the names of the first 10 drugs under Part D selected for Medicare drug price negotiations.
The group said high levels of market concentration is leaving millions of Americans with limited competitive options for health insurance.