DEAR DR. ROACH: When I have appointments with my physicians (at our local, highly rated academic health system), they no longer do a physical exam. But in the after-visit note, there is a documented ...

Andrew S. Oseran, MD, MBA, MSc, hypothesizes that higher Medicare Advantage (MA) risk scores may result from either a more accurate capture of beneficiaries' comorbidities or inappropriate "upcoding" ...

Despite criticisms over inaction, the HHS is aware of the flurry of fraud in the Medicare Advantage program that’s costing the government billions of dollars a year, and is thinking about how to curb ...

High-intensity billing during "treat and release" emergency department stays rose significantly from 2006 to 2019, and was partially fueled by factors such as changes in case mix and service offering ...

A Medicare Advantage plan run by CVS inflated diagnoses for its members between 2018 and 2019, resulting in almost $7 million in estimated overpayments, according to a new audit by the HHS Office of ...

Vivian Ho ([email protected]), Rice University and Baylor College of Medicine, Houston, Texas. Sasathorn Tapaneeyakul, Rice University. Heidi Voelker Russell, University of Texas, Houston, Texas.