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Justice Department Targets Data Mining in Medicare Advantage Fraud Case

By Fred Schulte September 14, 2021 KFF Health News Original

The feds’ civil suit links exaggerated patient bills to “tens of millions” in overcharges.

Morning Briefing for Monday, October 23, 2023

October 23, 2023 Morning Briefing

Opioid settlements, Medicare Advantage, finding covid shots, Medicaid enrollments, AI chatbots, dementia, and more are in the news.

Morning Briefing for Tuesday, November 7, 2023

November 7, 2023 Morning Briefing

Election Day, Medicare Advantage rules, gun violence, virus surveillance, abortion law, opioids, smoking, and more are in the news.

Morning Briefing for Thursday, October 19, 2023

October 19, 2023 Morning Briefing

Social Security clawbacks, maternal health, NIH nominee hearing, Medicare Advantage, Paxlovid cost, and more are in the news.

Should Older Seniors Risk Major Surgery? New Research Offers Guidance

By Judith Graham November 28, 2022 KFF Health News Original

An important new study offers much-needed data to inform older Americans of the risks and benefits they must weigh when facing major surgery.

‘Big 3’ Medicare Advantage Insurer Algorithms Deny 1 in 4 Post-Acute Care Requests: Probe

October 17, 2024 Morning Briefing

A Senate investigation found the three largest Medicare Advantage insurers have been increasingly denying seniors claims since adopting AI and algorithms to help streamline the approval process, reaching a nearly 1 in 4 denial rate since 2022.

Se acaba la era de las vacunas y las pruebas gratuitas contra covid. ¿Quién va a pagar?

By Julie Appleby February 10, 2023 KFF Health News Original

Las personas podrán obtener estas vacunas a bajo costo o sin costo mientras duren los suministros del gobierno. Luego, dependerá de su seguro de salud.

CMS To End Advance-Payment Program For Those Affected By Hack

June 18, 2024 Morning Briefing

The program, launched in March in the aftermath of the Change Healthcare cyberattack, sent advance payments to providers whose operations were disrupted. CMS also announced a do-over of 2024 quality scores for Medicare Advantage plans.

Medicare’s Open Enrollment Is Open Season for Scammers

By Susan Jaffe November 11, 2021 KFF Health News Original

Medicare officials say complaints are rising from seniors lured into private plans with misleading information or enrolled without their consent. In response, officials have threatened to penalize the private companies selling Medicare Advantage and drug plans if they or agents working on their behalf mislead consumers.

Now Included In First-Aid Guidelines: Overdoses, Seizures, And More

December 4, 2024 Morning Briefing

In the first update since 2010, the American Heart Association and the American Red Cross have included how to treat opioid overdoses and open chest wounds, among other things. Other industry news includes strikes, hospital closures, Medicare Advantage, and more.

House Passes Bill Barring Use Of QALY Metric In Federal Health Programs

February 8, 2024 Morning Briefing

The legislation would ban the use of quality-adjusted life years indexes when valuing medicines for federal health programs such as Medicaid, Medicare Advantage, and VA Health Care.

Survey Finds Nearly 80% Dissatisfied With Cost Of Health Care In US

December 9, 2024 Morning Briefing

In the lowest marks in over two decades, a Gallup poll finds that only 19% of Americans are satisfied with the costs of health care in 2024. Quality ratings suffer as well, with less than a majority of people giving “good” or “excellent.” And a separate survey looks at Medicare Advantage plans.

Morning Briefing for Wednesday, October 11, 2023

October 11, 2023 Morning Briefing

Abortion law, opioids, Medicare Advantage, covid, Medicaid enrollment, telehealth rules, sepsis, mental health, and more are in the news.

KFF Health News' 'What the Health?': Newly Minted Doctors Are Avoiding Abortion Ban States

May 9, 2024 Podcast

For the second year in a row, medical school graduates across specialties are shying away from applying for residency training in states with abortion bans or significant restrictions, according to a new study. Meanwhile, Medicare’s trustees report that the program will be able to pay its bills longer than expected — which could discourage Congress from acting to address the program’s long-term financial woes. Lauren Weber of The Washington Post, Joanne Kenen of the Johns Hopkins University schools of nursing and public health and Politico Magazine, and Anna Edney of Bloomberg News join KFF Health News’ Julie Rovner to discuss these stories and more.

KFF Health News' 'What the Health?': Congress Kicks the (Budget) Can Down the Road. Again.

November 16, 2023 Podcast

Congress narrowly avoided a federal government shutdown for the second time in six weeks, as Democrats came to the rescue of divided House Republicans over annual spending bills that were supposed to be finished by Oct. 1. But the brinksmanship is likely to repeat itself early in 2024, when the next temporary spending patches expire. Meanwhile, a pair of investigations unveiled this week demonstrate how difficult it still is for seniors to get needed long-term and rehabilitation care. Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat, and Joanne Kenen of Johns Hopkins University and Politico Magazine join KFF Health News’ Julie Rovner to discuss these issues and more.

From ‘Physician Assistant’ to Medicare, Readers and Tweeters Mince No Words

December 8, 2021 KFF Health News Original

KHN gives readers a chance to comment on a recent batch of stories.

Under Trump, Privately Run Health Care Plans Favored Over ACA And Medicaid

November 7, 2024 Morning Briefing

In the aftermath of the election, health care companies that offer federally funded plans, like ACA and Medicaid, are likely to suffer, while private ones, like Medicare Advantage, will likely benefit from the Republican win. Also, more about what to expect from the Trump presidency.

Once Off Limits, Medicare Cuts Now In The Mix As Senate Works On Tax Bill

June 6, 2025 Morning Briefing

Desperate to find savings in President Donald Trump’s budget bill, Senate Republicans are opening the door to changes to Medicare — which they previously indicated would not be a part of the legislation. Changes to target “waste and fraud” in private Medicare Advantage plans are high on the list. Meanwhile, news outlets also report cuts to Medicaid and the ACA are under consideration.

Insurers Overcharging Taxpayers For Medicare Advantage, Doctors Allege

October 11, 2023 Morning Briefing

The overcharging sum, Physicians for a National Health Program alleges, could be at least $88 billion a year. Meanwhile, Medicare Advantage’s predictive AI software is in the spotlight for cutting off care to people who need it. Also: a federal program to cut sepsis deaths, open enrollment, and more.

Why So Slow? Legislators Take on Insurers’ Delays in Approving Prescribed Treatments

By Michelle Andrews May 17, 2022 KFF Health News Original

Insurers say prior authorization requirements are intended to reduce wasteful and inappropriate health care spending. But they can baffle patients waiting for approval. And doctors say that insurers have yet to follow through on commitments to improve the process.

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