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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.

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.

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.

Sen. Grassley Demands Scrutiny Of Medicare Advantage Plans

By Fred Schulte April 18, 2017 KFF Health News Original

The powerful chairman of the Senate Judiciary Committee wants the Centers for Medicare and Medicaid Services to explain $125 million in overcharges by insurers.

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.”

5 Outside-The-Box Ideas For Fixing The Individual Insurance Market

By Julie Rovner August 30, 2017 KFF Health News Original

As lawmakers look for ways to stabilize the health law marketplaces, a number of ideas — such as expanding who can “buy in” to Medicare and Medicaid or pushing young adults off their parents’ plans into the marketplaces — might come into play.

1.84 Percent Rate Hike Proposed For Medicare Advantage Plans In 2019

February 2, 2018 Morning Briefing

The increase in what the federal government pays the plans was near to what analysts had expected.

Must-Reads Of The Week From Brianna Labuskes

By Brianna Labuskes June 8, 2018 KFF Health News Original

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

Medicare Directories Have Lots Of Errors, But Where The Blame Should Fall Isn’t Quite Clear Cut

February 1, 2018 Morning Briefing

Data accuracy depends on both doctors and health plans, an AHIP official said. Medicare Advantage plans depend on doctors to submit accurate and up-to-date information. Will a new review help?

CMS Wants To Adjust Payments For Medicare Advantage Plans

January 3, 2018 Morning Briefing

Under the proposed changes, risk scores used to set payments would take into account certain diagnoses of mental health disorders, substance abuse disorders and chronic kidney disease. Meanwhile, the Department of Health and Human Services has finalized a rule that offers providers and payers more flexibility to share substance abuse patients’ data.

Having Buyer’s Remorse Over Medicare Advantage Plan? You Can Still Switch Back

January 4, 2018 Morning Briefing

Medicare Advantage Disenrollment Period, which is open until Feb. 14, allows people enrolled in an Advantage plan for 2018 to switch to original Medicare. Meanwhile, in other Medicare news, the Centers for Medicare & Medicaid Services will start reviewing Advantage networks on three-year cycles.

Aetna’s Leadership Remains Mum On CVS Talks, But Posts Spike In Q3 Profit

November 1, 2017 Morning Briefing

The company touted growth in its Medicare Advantage enrollment.

Justice Department Joins Lawsuit Alleging Massive Medicare Fraud By UnitedHealth

By Fred Schulte March 28, 2017 KFF Health News Original

The Department of Justice is joining a whistleblower lawsuit in a fraud case against UnitedHealth in which damages could top $1 billion.

Drug Trade Group Quietly Spends ‘Dark Money’ To Sway Policy And Voters

By Jay Hancock July 30, 2018 KFF Health News Original

Grants by top pharma group to lightly regulated, politically active nonprofits dwarf its conventional campaign spending.

Gobierno se une a demanda en contra de UnitedHealth que alega fraude masivo al Medicare

By Fred Schulte March 28, 2017 KFF Health News Original

El Departamento de Justicia se ha unido a la demanda de un denunciante de California que acusa al gigante de seguros UnitedHealth Group de fraude en sus populares planes de salud de Medicare Advantage.

Anthem’s Retreat Leaves Californians With Fewer Choices, More Worries

By Pauline Bartolone and Anna Gorman and Chad Terhune August 2, 2017 KFF Health News Original

The nation’s second-largest insurer is shrinking its presence on Obamacare exchanges and in the broader individual market in response to prevailing uncertainty. California is just the latest — and the biggest — example.

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