UnitedHealth Confirms It’s Being Investigated Over Medicare Billing
The insurance giant said Thursday it is cooperating with the Department of Justice and responding to both formal criminal and civil requests, The New York Times reported.
The New York Times:
UnitedHealth Will Cooperate With Federal Probe Of Its Medicare Billing Practices
After months of unconfirmed reports about a potential federal probe into its Medicare business, UnitedHealth Group, the giant health care conglomerate, announced Thursday morning that it was cooperating with the U.S. Department of Justice and responding to both formal criminal and civil requests. UnitedHealth said it had “proactively reached out” to the Justice Department after news reports of a government investigation had surfaced, according to an unsigned company statement. (Abelson, 7/24)
Modern Healthcare:
Sanford, Alignment Execs Push For Medicare Advantage Competition
As Congress mulls changes to the Medicare Advantage program, smaller insurers are working to distance themselves from industry leaders. During a recent Modern Healthcare webinar, SCAN Group President and CEO Dr. Sachin Jain, Alignment Healthcare President Dawn Maroney and Sanford Health Plan President and CEO Dr. Tommy Ibrahim described themselves as smaller players reckoning with policies designed for the national heavyweights. (Tepper, 7/24)
Modern Healthcare:
Molina Healthcare To Seek Mergers, Acquisitions To Boost Finances
Molina Healthcare plans to pursue mergers and acquisitions to offset rising claims and medical costs. The insurer, whose core businesses are Medicaid, Medicare and the insurance exchanges, again cut its 2025 financial guidance Thursday as it reported second-quarter earnings. (DeSilva, 7/24)
Modern Healthcare:
PACE Expansions Need Regulatory Changes, Execs Say
Executives said high start-up costs combined with complex federal and state requirements make it harder for them to grow a state and federal program aimed at keeping older adults out of nursing homes. Programs of All-Inclusive Care for the Elderly offer in-home and center-based care to mostly dual-eligible Medicare and Medicaid enrollees who qualify for skilled nursing facilities, but can remain in their homes. There are approximately 180 PACE programs across 33 states with more than 100 providers interested in starting new programs over the next five years, the National PACE Association said. (Eastabrook, 7/24)
Stat:
CMS Is Testing Prior Authorization In Traditional Medicare
For both patients and clinicians, one of the advantages of traditional Medicare is that it almost entirely lacks the onerous preauthorization reviews that plague the program’s privately administered Medicare Advantage option. But under a new demonstration program recently announced by the Centers for Medicare and Medicaid Services, that’s about to change. Preauthorization is about to enter the lives of seniors who have chosen traditional Medicare over Medicare Advantage (MA). (Berwick and Ducas, 7/25)
More on Medicaid and ACA —
Stat:
Hospitals Get $4 Billion Medicaid Boost — Ahead Of Tax Law Cuts
The federal government has approved more than $4 billion in extra Medicaid funds that will be routed to hospitals, doctors, nursing homes, and other providers this year — just in time before Republicans’ new tax law begins to phase out these bonus payments. The vast majority of the new Medicaid funds, known as “state directed payments,” are for medical providers in New Mexico and West Virginia. (Herman, 7/25)
The 19th:
Over A Million LGBTQ+ Women Rely On Medicaid. What Happens If They Lose It?
Sara Habein, a mother of two living in northern Montana, recently learned that she has cysts in her brain. Every six months, her doctors want to check that the cysts aren’t growing. She may need surgery if they get larger and put too much pressure on her brain. If she didn’t have Medicaid, she would either be racking up costs on a payment plan or would have to make a difficult decision about the various other medications and treatments she needs for chronic health issues — all of which she relies on Medicaid to cover. (Rummler and Carrazana, 7/24)
KFF Health News:
KFF Health News’ ‘What The Health?’: Here Come The ACA Premium Hikes
Much of the hubbub in health care this year has been focused on Medicaid, which faces dramatically reduced federal funding as the result of the huge budget bill signed by President Donald Trump earlier this month. But now the attention is turning to the Affordable Care Act, which is facing some big changes that could cost many consumers their health coverage as soon as 2026. (Rovner, 7/24)
