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Whistleblowers: United Healthcare Hid Complaints About Medicare Advantage

By Fred Schulte July 28, 2017 KFF Health News Original

A Wisconsin lawsuit alleges United Healthcare downplayed abusive sales tactics to avoid losing government bonuses.

Medicare’s Power To Negotiate Drug Prices Will Harm Patients With Chronic Illnesses, Advocates Warn

August 9, 2018 Morning Briefing

Medicare Advantage’s negotiating tool — requiring patients to try lower-cost treatments before the more expensive ones — is derided as a “fail first” process to those who oppose the strategy. “Consumers may have to go through one or more drugs before they can get a particular treatment they really need,” said Ellen Albritton, a senior policy analyst at Families USA. Meanwhile, there are already signals that implementing the new rules is going to be complicated.

The Doctors Want In: Democratic Docs Talk Health Care On The Campaign Trail

By Shefali Luthra August 27, 2018 KFF Health News Original

Among candidates running for Congress in upcoming elections are a smattering of left-leaning physicians who present a stark contrast to the predominantly Republican physicians currently in office.

Must-Reads Of The Week From Brianna Labuskes

By Brianna Labuskes October 12, 2018 KFF Health News Original

Newsletter editor Brianna Labuskes wades through hundreds of health articles from the week so you don’t have to.

Community Hospitals Link Arms With Prestigious Facilities To Raise Their Profiles

By Sandra G. Boodman January 29, 2019 KFF Health News Original

A growing number of community hospitals are forming alliances with some of the nation’s biggest and most prestigious institutions. But for prospective patients, it can be hard to assess what these relationships actually mean.

Medicare Eases Readmission Penalties Against Safety-Net Hospitals

By Jordan Rau September 26, 2018 KFF Health News Original

Penalties will total $566 million for all hospitals. But many that serve a large share of low-income patients will lose less money than they did in previous years.

UnitedHealth Doctored Medicare Records, Overbilled U.S. By $1 Billion, Feds Claim

By Fred Schulte May 17, 2017 KFF Health News Original

The company, which is the nation’s largest Medicare Advantage operator, denies wrongdoing and argues that the Justice Department “fundamentally misunderstands” how Medicare Advantage works.

Must-Reads Of The Week From Brianna Labuskes

By Brianna Labuskes October 5, 2018 KFF Health News Original

Newsletter editor Brianna Labuskes wades through hundreds of health articles from the week so you don’t have to.

As Seniors Get Sicker, They’re More Likely To Drop Medicare Advantage Plans

By Fred Schulte July 6, 2017 KFF Health News Original

Medicare Advantage plans offer good value and aim to keep patients healthy but sicker people are far more likely to quit because they can’t get the care they need.

Measure To Cap Dialysis Profits Pummeled After Record Spending By Industry

By Ana B. Ibarra and Anna Gorman November 8, 2018 KFF Health News Original

The dialysis industry raised nearly $111 million in a successful bid to defeat the measure, which also was opposed by hospitals and doctors. The union that sponsored the measure collected about one-sixth that amount.

As 2020 Candidates Go Big And Bold On Health Ideas, Voters Say They Just Want Someone To Bring Costs Down

June 24, 2019 Morning Briefing

Many of the candidates are pushing “Medicare for All” or some variation of expanded government-supported health care. While many voters see the plans as aspirational, for now, they simply want to pay less for their health care. That disconnect between what politicians are preaching and what voters are worried about could be detrimental to Democrats, who polls show currently hold an advantage over Republicans when it comes to the issue of health care. Meanwhile, media organizations help you navigate the candidates’ stances on health.

Fraud And Billing Mistakes Cost Medicare — And Taxpayers — Tens Of Billions Last Year

By Fred Schulte July 19, 2017 KFF Health News Original

At a hearing Wednesday, federal health officials pointed to billing errors, fraud and overcharges that led Medicare to overpay by staggering sums.

Social Security Giveth, Medical Costs Taketh Away

By Michelle Andrews October 13, 2017 KFF Health News Original

Out-of-pocket health costs eat up about 18 percent of retirees’ incomes.

Two Medicare Advantage Insurers Settle Whistleblower Lawsuit For $32 Million

By Fred Schulte May 30, 2017 KFF Health News Original

Freedom Health and Optimum HealthCare agreed to settle a lawsuit alleging they overbilled Medicare.

Medicare Advantage Plans To Get 3.4% Pay Hike In 2019, Well Over Initial Proposal

April 3, 2018 Morning Briefing

CMS Administrator Seema Verma says the payment bump reflects higher projections for how much Medicare spending will increase next year.

Research Roundup: Medicare Advantage, Medicaid And Diabetes Coaching

February 9, 2018 Morning Briefing

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Strong Medicare Advantage Growth Helps Humana Beat Q4 Revenue Projections

February 8, 2018 Morning Briefing

The insurer’s revenue, driven largely by Medicare Advantage premiums, grew 3.8 percent to $10.2 million in the fourth quarter of 2017.

Nursing Homes Move Into The Insurance Business

By Jordan Rau July 13, 2017 KFF Health News Original

Although proponents say the policies offered by nursing homes are more attuned to patients, some report frustrations when trying to dispute care decisions.

Liquid Gold: Pain Doctors Soak Up Profits By Screening Urine For Drugs

By Fred Schulte and Elizabeth Lucas Photos by Heidi de Marco November 6, 2017 KFF Health News Original

With the nation’s opioid crisis, urine testing has become a booming business and is especially lucrative for doctors who operate their own labs, a Kaiser Health News investigation finds. And dozens of practitioners have earned “the lion’s share” of their Medicare income exclusively from urine drug screens.

Whistleblower: Medicaid Managed-Care Firm Improperly Denied Care To Thousands

By Chad Terhune December 1, 2017 KFF Health News Original

An explosive report prepared by a SynerMed executive alleges the California firm, which oversaw care for 1.2 million patients, fabricated documents and violated state and federal regulations for years. The state says it left low-income patients on Medicaid managed care in “imminent danger.”

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