Latest KFF Health News Stories
Blurry Line Between Medical and Vision Insurance Leaves Patient With Unexpected Bill
A Wisconsin retiree with glaucoma needed her eyes examined. Her Medicare Advantage plan from UnitedHealthcare listed her optometrist’s clinic as in-network, but she learned the hard way that a clinic can be in-network and out-of-network at the same time.
What the Health? From KFF Health News: The Hazards of ICE for Public Health
The Trump administration’s immigration crackdown is not just roiling politics but also directly affecting the provision of health care, medical groups say. Meanwhile, in Washington, federal spending bills have been stalled by the fight over immigration enforcement funding after the shooting death of a second person in Minneapolis this month. Maya Goldman of Axios, Alice Miranda Ollstein of Politico, and Rachel Roubein of The Washington Post join KFF Health News’ Julie Rovner to discuss those stories and more.
Medicare Advantage Insurers Face New Curbs on Overcharges in Trump Plan That Reins in Payments
Proposed Trump administration changes to federal Medicare Advantage payments would stop health insurers from mining patient data for extra medical diagnoses that generate more bills to taxpayers even without treatment.
Sick of Fighting Insurers, Hospitals Offer Their Own Medicare Advantage Plans
Breakups between insurers and health systems, on top of plan cuts, left more than 3.7 million Medicare Advantage enrollees facing a tough choice last year: find new insurance or new doctors. But hospital systems say their Advantage plans can avert such upheaval, giving patients peace of mind.
Kaiser Permanente To Pay $556 Million in Record Medicare Advantage Fraud Settlement
Kaiser Permanente agrees to pay $556 million to settle allegations of billing the government for conditions patients didn’t have.
Las quejas sobre deficiencias en Medicare Advantage son comunes, pero la supervisión federal es rara
Documentos gubernamentales obtenidos por KFF Health News muestran que la agencia que supervisa Medicare Advantage no se esfuerza por hacer cumplir normas vigentes.
Complaints About Gaps in Medicare Advantage Networks Are Common. Federal Enforcement Is Rare.
Health systems drop out of Medicare Advantage plans all the time. Yet government documents obtained by KFF Health News show that federal regulators rarely warn plans that their networks of health providers are so skimpy they violate legal requirements.
Private Medicare, Medicaid Plans Exaggerate In-Network Mental Health Options, Watchdogs Say
A federal probe of Medicare and Medicaid plans run by private insurance companies found that the plan operators often overstated how many mental health providers were available in their networks. In some cases, investigators found providers had never had contracts with plans they were listed on.
La inteligencia artificial pronto influirá en que te aprueben o te nieguen tratamientos en Medicare
Siguiendo el ejemplo del sector privado de seguros, la administración Trump lanzará el próximo año un programa piloto.
AI Will Soon Have a Say in Approving or Denying Medicare Treatments
A pilot program testing the use of artificial intelligence to expand prior authorization decisions in Medicare has providers, politicians, and researchers questioning Trump administration promises to curb an unpopular practice that has frustrated patients and their doctors.
Trump’s DOJ Accuses Medicare Advantage Insurers of Paying ‘Kickbacks’ to Brokers
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Trump’s DOJ Accuses Medicare Advantage Insurers of Paying ‘Kickbacks’ for Primo Customers
The Department of Justice alleges that several major health insurers paid brokerages “hundreds of millions of dollars in kickbacks” to get agents to steer consumers into their Medicare Advantage plans, allegations the insurers strongly dispute.
When Hospitals Ditch Medicare Advantage Plans, Thousands of Members Get To Leave, Too
Breakups between health providers and Advantage plans are increasingly common. The Centers for Medicare & Medicaid Services has allowed whole groups of patients to leave their plans.
What the Health? From KFF Health News: Can Congress Reconcile Trump’s Wishes With Medicaid’s Needs?
When Congress returns next week, it will be writing a budget reconciliation bill that’s expected to cut taxes but also make deep cuts to Medicaid. But at least some Republicans are concerned about cutting a program that aids so many of their constituents. Sarah Karlin-Smith of the Pink Sheet, Tami Luhby of CNN, and Alice Miranda Ollstein of Politico join KFF Health News’ Julie Rovner to discuss this story and more. Also, Rovner interviews KFF Health News’ Rae Ellen Bichell about her story on how care for transgender minors is changing in Colorado.
Some Rural Hospitals Ditch Medicare Advantage
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Rural Hospitals Question Whether They Can Afford Medicare Advantage Contracts
Some rural hospitals have canceled — or are considering ending — contracts with insurance companies that offer Medicare Advantage plans, saying the private policies jeopardize their finances and impede patient care.
UnitedHealth Wins Ruling Over $2B in Alleged Medicare Advantage Overpayments
A special master found the Justice Department failed to prove wrongdoing by the giant health insurer.
In Settling Fraud Case, New York Medicare Advantage Insurer, CEO Will Pay up to $100M
A whistleblower suit alleged a health insurer bilked Medicare by exaggerating how sick patients were.
Federal Watchdog Urges Crackdown on Medicare Advantage Home Visits
Medicare officials are pushing back against a federal watchdog’s call to crack down on home visits by Medicare Advantage health plans — a practice the watchdog says may waste billions of tax dollars every year. In late October, a Health and Human Services inspector general audit found that the insurers pocketed $7.5 billion in 2023 from diagnosing health conditions that […]
TV’s Dr. Oz Invested in Businesses Regulated by Agency Trump Wants Him To Lead
Celebrity doctor Mehmet Oz recently held broad investments in health care, tech, and food companies. Were he confirmed to run the Centers for Medicare & Medicaid Services, his job would involve interacting with giants of the industry that have contributed to his wealth.
