The independent source for health policy research, polling, and news.
Chad Terhune was a senior correspondent for KFF Health News until November 2018.
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Managed-care plans, which reap billions in taxpayer dollars to coordinate care for low-income Americans on Medicaid, outsource crucial treatment decisions to subcontractors that aren’t directly accountable to the government. In California, health officials say one firm improperly withheld or delayed care for hundreds of people.
The money was paid on behalf of more than 400,000 people who may have been ineligible for the public program, a state audit found. One had been dead for four years before payments stopped.
Insurance companies profit from government contracts but are subject to little oversight of how they spend the money or care for patients. The expansion of Medicaid under the Affordable Care Act has only exacerbated the problem.
Amid the buzz over apps and electronic medical records rescuing modern medicine, California’s Medicaid program still clings to 1970s-era technology. A reboot may cost half a billion dollars.
A Health Affairs study quantifies the financial effects of such mergers on consumers and their insurers. The hospital industry and doctor practices say the consolidation leads to better coordination of care.
“I don’t feel any consumer should have to go through this,” says Drew Calver, who faced a life-changing surprise bill from an Austin hospital after a heart attack last year. After attention as a "Bill of the Month" patient, he paid the hospital $332. But he worries about other patients with surprise bills.
A Texas teacher, 44, faces a “balance bill” of almost twice his annual salary for a heart attack he never expected to have.
California’s third-largest insurer faces anger from customers in the individual market who unexpectedly lost their insurance despite paying premiums faithfully. In its recently filed lawsuit, the company blamed a contractor for “egregious” billing problems.
After a San Francisco speech focused mostly on Medicare, Seema Verma fielded questions that underscored the administration’s differences with California on other key health care issues.
The average increase in California is smaller than the double-digit hikes expected around the nation, due largely to a healthier mix of enrollees and more competition in its marketplace. Still, health insurance prices keep growing faster than wages and general inflation.
Medicaid has struggled for years with poor oversight and billions lost to improper payments. A new report finds that despite their fraud-fighting rhetoric, Medicaid managed-care companies are not as rigorous as they should be in ensuring the integrity of the Medicaid payment system.
With the primary now over, health care may well emerge as an issue that helps voters distinguish between candidates for governor, attorney general and other offices in the general election.
In a case with possible national repercussions, the state’s attorney general has sued over alleged price gouging, and other legal and legislative challenges are afoot. Sutter is pushing back hard, denying anticompetitive behavior.
The ‘scary’ findings show a discouraging lack of progress in cleaning the devices, despite more vigorous efforts in the wake of deadly superbug outbreaks, experts say.
The lawsuit is a bold move against Northern California’s dominant hospital chain, whose prices have drawn complaints for years. It has disputed such allegations in the past.
The legislation is intended to curb schemes in which some treatment providers sign patients up for private plans, pay their premiums and then rake in profits from inflated claims.
California health officials do not dispute most of the findings, saying they have already made improvements in determining eligibility.
How a California health plan’s CEO and her husband, an executive consultant, got rich off the taxpayer-funded program for the poor. Critics see a conflict of interest, the plan doesn’t, and the state has no rules either way.
The Seattle jurist finds that Olympus Corp. failed to properly disclose evidence that it knew of concerns about cleaning problems with its redesigned medical scopes years before they hit the market and were linked to dozens of deaths. The company maintains the devices were not defective and intends to appeal.
An explosive report prepared by a SynerMed executive alleges the California firm, which oversaw care for 1.2 million patients, fabricated documents and violated state and federal regulations for years. The state says it left low-income patients on Medicaid managed care in “imminent danger.”
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