Latest KFF Health News Stories
How Medicare Advantage Plans Dodged Auditors and Overcharged Taxpayers by Millions
Facing rare scrutiny from federal auditors, some Medicare Advantage health plans failed to produce any records to justify their payments, government records show. The audits revealed millions of dollars in overcharges to Medicare over three years.
KHN Investigation: The System Feds Rely On to Stop Repeat Health Fraud Is Broken
A months-long KHN examination of the system meant to bar fraudsters from Medicaid, Medicare, and other federal health programs found gaping holes and expansive gray areas through which banned individuals slip to repeatedly bilk taxpayer-funded programs.
KHN’s ‘What the Health?’: Congress Races the Clock
Sen. Raphael Warnock’s re-election in Georgia will give Democrats a clear-cut Senate majority for the first time in nearly a decade. Meanwhile, the current Congress has only days left to tackle major unfinished business on the health agenda, including fending off scheduled pay cuts for doctors and other health providers in the Medicare program. Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, Anna Edney of Bloomberg News, and Sandhya Raman of CQ Roll Call join KHN’s Julie Rovner to discuss these topics and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too.
Audits — Hidden Until Now — Reveal Millions in Medicare Advantage Overcharges
Taxpayers had to foot the bills for care that should have cost far less, according to records released after KHN filed a lawsuit under the Freedom of Information Act. The government may seek to recover up to $650 million as a result.
Path Cleared for Georgia to Launch Work Requirements for Medicaid
Federal officials have apparently stopped fighting Georgia’s plan for a limited Medicaid expansion that includes work requirements. The plan, a key policy of Republican Gov. Brian Kemp’s, would cover a much smaller portion of the population: those who can work or volunteer 80 hours a month.
Cómo el optimismo puede cerrar la brecha de cobertura de Medicaid
Más de 2 millones de personas de bajos ingresos, la mitad de ellos en Florida y Texas, no tienen seguro porque están atrapados en una brecha de cobertura. Y sus estados no han expandido Medicaid.
How Optimism Can Close the Medicaid Coverage Gap
Low-income residents in states that haven’t expanded Medicaid are in a tough spot: They don’t qualify for the subsidies that people with slightly higher incomes get to buy marketplace plans because of a glitch in the federal health law. But a court decision last year makes it easier for them to make good-faith estimates of a pay increase, and there is no financial penalty if they don’t hit that figure.
Medicare Plan Finder Likely Won’t Note New $35 Cap on Out-of-Pocket Insulin Costs
In August, Congress approved a $35 cap on what seniors will pay for insulin, but that change came too late to add to the online tool that helps Medicare beneficiaries compare dozens of drug and medical plans. Federal officials say beneficiaries who use insulin will have the opportunity to switch plans after open enrollment ends Dec. 7.
After Congress Fails to Add Dental Coverage, Medicare Weighs Limited Benefit Expansion
Medicare can pay for some dental care if it is medically necessary to safely treat another covered medical condition, and federal officials have asked for suggestions on whether that list of conditions should be expanded.
Lawsuit by KHN Prompts Government to Release Medicare Advantage Audits
The lawsuit was filed three years ago to learn about vast overcharges by the popular health plans that are detailed in audits the government refused to release to the public.
Nursing Home Surprise: Advantage Plans May Shorten Stays to Less Time Than Medicare Covers
Private Medicare Advantage health plans are increasingly ending coverage for skilled nursing or rehab services before medical providers think patients are healthy enough to go home, doctors and patient advocates say.
In an industry obsessed with consumer satisfaction national patient surveys still don’t get at an important question: Are hospitals delivering culturally competent care?
Rapper Fat Joe Says No One Is Making Sure Hospitals Post Their Prices
A TV and social media ad offers a reason to check on the enforcement of a sweeping rule that requires hospitals to post information about what they charge insurers and cash-paying patients.
Even Well-Intended Laws Can’t Protect Us From Inaccurate Provider Directories
State and federal laws require health plans to offer accurate lists of participating doctors and facilities, but consumers still struggle to get timely appointments with providers.
Rural Hospital Rescue Program Is Met With Skepticism From Administrators
A new federal rescue program that pays rural hospitals to shutter underused inpatient units and focus solely on emergency rooms and outpatient care hasn’t generated much interest yet.
Feds Want a Policy That Advocates Say Would Let Hospitals Off the Hook for Covid-Era Lapses
The pandemic disrupted all sense of normalcy for U.S. hospitals, so federal officials are proposing to pause financial penalties against the facilities and to block public access to key hospital safety data — such as the frequency of falls and sepsis — because of concerns that the data isn’t accurate enough. But consumer advocates are furious about the proposal.
Government Watchdogs Attack Medicare Advantage for Denying Care and Overcharging
The Government Accountability Office and the Health and Human Services inspector general’s office say seniors enrolled in the program are suffering and taxpayers are getting bilked for billions of dollars a year.
Buy and Bust: When Private Equity Comes for Rural Hospitals
Noble Health swept into two small Missouri towns promising to save their hospitals. Instead, workers and vendors say it stopped paying bills and government inspectors found it put patients at risk. Within two years — after taking millions in federal covid relief and big administrative fees — it locked the doors.
Medicaid Weighs Attaching Strings to Nursing Home Payments to Improve Patient Care
The Biden administration is considering whether Medicaid, which pays the bills for 62% of nursing home residents, should require that most of that funding be used to provide care, rather than for maintenance, capital improvements, or profits.
They Thought They Were Buying Obamacare Plans. What They Got Wasn’t Insurance.
Some consumers who think they are signing up for Obamacare insurance find out later they actually purchased a membership to a health care sharing ministry. But regulators and online advertising sites don’t do much about it.
