Kaiser Permanente Settles Lawsuits Over Fraud, Data-Sharing Allegations
Affiliates of the California-based health care provider have agreed to pay $556 million to settle claims that KP bilked Medicare by bumping up diagnoses to reap more reimbursements. Plus: The United States spent $5.28 trillion on health care in 2024, a CMS report shows.
San Francisco Chronicle:
Kaiser Affiliates To Pay $556 Million In Medicare Fraud Scheme
Kaiser Permanente affiliates were ordered to pay $556 million to settle a lawsuit alleging that the healthcare provider defrauded Medicare by using falsified medical information to increase reimbursements, the Justice Department said. The settlement puts an end to claims that affiliates of Kaiser Permanente — the Oakland-based healthcare giant — violated federal law by pressuring doctors to add certain diagnoses to patients’ medical records after visits had already happened, according to the Justice Department. That allowed Kaiser to receive higher payments from Medicare Advantage, the federal records say. (Toledo, 1/14)
San Francisco Chronicle:
Kaiser Permanente Data Settlement: Who Qualifies For Payment
Certain current and former Kaiser Permanente members may be eligible for a cash payment under a proposed $46 million class-action settlement tied to allegations that the health care provider improperly shared sensitive patient data through online tracking tools. The settlement has received preliminary approval from a federal judge. It resolves a series of lawsuits accusing Kaiser of allowing third-party tracking code on its websites and mobile applications to transmit personal and health-related information without patients’ consent. The Oakland-based nonprofit health organization has 12.6 million members. (Vaziri, 1/14)
In other Medicare Advantage news —
Modern Healthcare:
Alignment Healthcare Plans Medicare Advantage Expansion
Alignment Healthcare is preparing for a major market expansion in 2027 after recording a substantial increase in members during the past year. Earlier this week, the Medicare Advantage insurer said it covered 275,300 members as of Jan. 1, a 31% increase from a year ago. (Tepper, 1/14)
Modern Healthcare:
UnitedHealthcare To Launch Rural Payment Acceleration Pilot
UnitedHealthcare is launching a program intended to speed up Medicare Advantage payments for rural hospitals. The Rural Payment Acceleration Pilot will run for the next six months and focus on halving Medicare Advantage average payment timelines to less than 15 days, the UnitedHealth Group subsidiary said in a news release Wednesday. (DeSilva, 1/14)
More on health care costs and coverage —
Modern Healthcare:
Health Spending Rose To $5.3T In 2024, CMS Actuaries Report
The U.S. spent $5.28 trillion on healthcare in 2024, a 7.2% increase from the prior year, the Centers for Medicare and Medicaid Services Office of the Actuary reported Wednesday. Healthcare accounted for 18% of gross domestic product in 2024, up slightly from 2023, the actuaries wrote in the journal Health Affairs. The independent CMS division attributes the spending spike to higher use and intensity of healthcare services and products. (Early, 1/14)
The Boston Globe:
Massachusetts Health Insurance Prior Authorizations To Face Restrictions, Healey Says
Massachusetts health insurers will face new restrictions around the much-maligned practice of prior authorizations, eliminating the red tape around how patients access some drugs and services, Governor Maura Healey said Wednesday. Healey announced at the State House that the Division of Insurance will establish regulations to eliminate any insurer permissions required for many routine and essential services. The changes, along with some other reforms, take aim at a practice that’s long drawn the ire of many consumers upset over insurer denials. (Bartlett, 1/14)
CBS News:
Retired Georgia Couple Hit With $39,000 Health Insurance Bill After ACA Subsidies End
Barbara Brockway and Matt Padula's monthly insurance premiums have doubled after the lapse of enhanced Affordable Care Act subsidies. In 2025, the couple paid about $1,600 a month. Now, their monthly premium has doubled to $3,200 — totaling nearly $39,000 a year for insurance alone. (Montgomery, 1/14)
KFF Health News:
GOP Cuts Will Cripple Medicaid Enrollment, Warns CEO Of Largest Public Health Plan
When the head of the nation’s largest publicly operated health plan worries about the looming federal cuts to Medicaid, it’s not just her job. It’s personal. Martha Santana-Chin, the daughter of Mexican immigrants, grew up on Medi-Cal, California’s version of Medicaid, the government-run health care program for people with low incomes and disabilities. Today, she is CEO of L.A. Care, which runs by far the biggest Medi-Cal health plan, with more than 2.2 million enrollees, exceeding the Medicaid and Children’s Health Insurance Program enrollments in 41 states. (Wolfson, 1/15)
Modern Healthcare:
How A Federal Reserve Interest Rate Cut May Hit Insurer Earnings
Health insurers struggling with rising medical expenses may have less of a cushion in 2026. Companies such as UnitedHealth Group reaped gains on their investments over the past several years that bolstered their finances and offset narrowing profit margins or losses from operations. (Tepper, 1/14)
On health care workers —
The New York Times:
As N.Y.C. Nurses’ Strike Continues, Both Sides Prepare For A Long Fight
Two days into the largest nursing strike New York City has seen in decades, Mount Sinai Hospital made a startling accusation. Three nurses had been fired, administrators said, after they were caught “deliberately sabotaging” the labor-and-delivery floor by hiding critical supplies for newborns so that replacement nurses would not find them. “This is completely unacceptable behavior,” the hospital said in a statement on Tuesday, adding that the action last week risked “interfering with patient safety.” (Goldstein, 1/14)
HR Dive:
Gender Pay Gap In Healthcare Still Exists, Analysis Shows
The gender wage gap persists in healthcare despite women making up the majority share of workers in that industry, according to data analysis by Premier Law Group, which represents plaintiffs in healthcare lawsuits. For example, women registered nurses earn $0.91 for every $1.00 earned by male registered nurses. “The ongoing pay gap and underrepresentation of women in leadership roles within the healthcare sector are not just disparities,” the firm’s analysts said in a statement. “They represent structural inequalities that hinder the industry’s growth and stability.” (Colvin, 1/14)
Stat:
Biomedical Student Enrollment Rose In 2025 But Warning Signs Loom
The first year of President Trump’s second term rattled academic science, raising fears would-be biomedical researchers would avoid the field. New data on student enrollment, however, paint a more complicated picture. (Wosen, 1/15)
