The Medicare Advantage Influence Machine
New court filings and lobbying reports reveal an industry drive to tamp down critics — and retain billions of dollars in overcharges.
CMS
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Rural NC County Is Set To Reopen Its Shuttered Hospital With Help From a New Federal Program
One rural North Carolina county is on track to be among the first where a hospital reopens owing to a new federal hospital classification meant to help save small, struggling facilities.
By Taylor Sisk -
ACA Enrollment Platforms Suspended Over Alleged Foreign Access to Consumer Data
Federal regulators provided more specifics about why they suspended two private sector Affordable Care Act enrollment sites, including concerns about potential overseas accessing of consumer data and suspicions of involvement in Obamacare enrollment and switching schemes. The companies reject the assertions.
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Feds Killed Plan To Curb Medicare Advantage Overbilling After Industry Opposition
A private 2014 decision by the Centers for Medicare & Medicaid Services faces new scrutiny in a multibillion-dollar Justice Department fraud case against UnitedHealth Group.
By Fred Schulte -
Biden Administration Tightens Broker Access to Healthcare.gov To Thwart Rogue Sign-Ups
The Centers for Medicare & Medicaid Services said it has received more than 200,000 complaints in the first six months of the year about people being signed up for Obamacare plans or switched to new plans without their consent.
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Trump Is Wrong in Claiming Full Credit for Lowering Insulin Prices
Though the Trump administration established a voluntary, temporary program lowering insulin costs for some older Americans on Medicare, the mandatory price caps implemented through Biden’s Inflation Reduction Act go significantly further.
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HealthSherpa and Insurers Team Up To Curb Unauthorized ACA Enrollment Schemes
The initiative targets the biggest incentive driving fraudulent sign-ups and plan switches: the commissions that rogue agents or large call centers seek.
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The Supreme Court Just Limited Federal Power. Health Care Is Feeling the Shockwaves.
A Supreme Court ruling restricting federal power will likely have seismic ramifications for health policy. A flood of litigation — with plaintiffs like small businesses, drugmakers, and hospitals challenging regulations they say are too expensive or burdensome and not authorized by law — could leave the country with a patchwork of disparate health regulations.
Nursing Home Staffing Rules Prompt Pushback
Episode 350The nursing home industry — as well as a healthy number of Congress members — are all pushing back on the Biden administration’s new rules on nursing home staffing. Industry officials say that there are not enough workers to meet the requirements and that the costs would be prohibitive. Meanwhile, Democrats on Capitol Hill are trying to force Republicans to explain their exact positions on assuring access to contraceptives and in vitro fertilization. Rachel Cohrs Zhang of Stat, Alice Miranda Ollstein of Politico, and Sandhya Raman of CQ Roll Call join KFF Health News’ Julie Rovner to discuss these stories and more. Also this week, Rovner interviews KFF Health News’ Bram Sable-Smith, who reported and wrote the latest KFF Health News-NPR “Bill of the Month” feature about a free cruise that turned out to be anything but.
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Exclusive: Senator Urges Biden Administration To Thwart Fraudulent Obamacare Enrollments
With tens of thousands of Americans already affected by enrollment scams that leave some without doctors or treatments, Oregon Sen. Ron Wyden wants increased enforcement against rogue agents or other perpetrators and legislation to allow for criminal penalties.
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Journalists Demystify Bird Flu, Brain Worms, and New Staffing Mandates for Nursing Homes
KFF Health News and California Healthline staff made the rounds on national and local media in recent weeks to discuss topical stories. Here’s a collection of their appearances.
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Biden Administration Sets Higher Staffing Mandates. Most Nursing Homes Don’t Meet Them.
The staffing regulation was disparaged by the industry as unattainable. Patient advocates say it doesn’t go far enough. Labor unions welcomed the requirement.
By Jordan Rau -
Lawsuit Alleges Obamacare Plan-Switching Scheme Targeted Low-Income Consumers
The lawsuit filed in federal court alleges that large call centers were used to enroll people into Affordable Care Act plans or to switch their coverage, all without their permission.
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When Rogue Brokers Switch People’s ACA Policies, Tax Surprises Can Follow
Some tax filers’ returns are being rejected because they failed to provide information about Affordable Care Act coverage they didn’t even know they had.
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Your Doctor or Your Insurer? Little-Known Rules May Ease the Choice in Medicare Advantage
Disputes between hospitals and Medicare Advantage plans are leading to entire hospital systems suddenly leaving insurance networks. Patients are left stuck in the middle, choosing between their doctors and their insurance plan. There’s a way out.
By Susan Jaffe -
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Readers Slam Hospital Monopolies and Blame the Feds for Understaffed Nursing Homes
KFF Health News gives readers a chance to comment on a recent batch of stories.