‘Dark Money’ Group Angles for Higher Medicare Advantage Payments
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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.
By Susan Jaffe -
Some Rural Hospitals Ditch Medicare Advantage
Get our weekly newsletter, The Week in Brief, featuring a roundup of our original coverage, Fridays at 2 p.m. ET.
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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.
By Fred Schulte -
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.
By Susan Jaffe -
Medicare Advantage ‘Dark Money’ Group Attempts To Win Higher Payments for Insurance Companies
Medicare Advantage insurers say a proposal by the Trump administration to keep their payments nearly flat next year may lead to service cuts that harm seniors struggling to afford health care. A decision is due by early next month.
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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.
By Fred Schulte -
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.
By Fred Schulte and Holly K. Hacker -
Trump’s DOJ Accuses Medicare Advantage Insurers of Paying ‘Kickbacks’ to Brokers
Get our weekly newsletter, The Week in Brief, featuring a roundup of our original coverage, Fridays at 2 p.m. ET.
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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.
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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.
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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.
By Fred Schulte -
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.
By Susan Jaffe -
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Watchdog Calls for Tighter Scrutiny of Medicare Advantage Home Visits
Medicare officials defend the use of home visits that often spot medical conditions that are never treated.
By Fred Schulte -
KFF Health News Sues To Force Disclosure of Medicare Advantage Audit Records
Freedom of Information Act case targets HHS inspector general’s reviews of billions of dollars in health plan overpayments.
By Fred Schulte -
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.
By Fred Schulte -
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 -
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