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.
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Kaiser Permanente Back in the Hot Seat Over Mental Health Care, but It’s Not Only a KP Issue
Mental health workers on strike in Southern California say Kaiser Permanente is woefully understaffed, its therapists are burned out, and patients are often denied timely access to care. The insurer says it has largely fixed the problem. But across California and the nation, mental health parity is still not a reality.
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Massive Kaiser Permanente Strike Looms as Talks Head to the Wire
Both sides, still at loggerheads over pay and staffing, agreed to keep bargaining after unions announced a possible strike Oct. 4-7. If no deal is reached, a walkout by about 75,000 KP workers in five states could disrupt care.
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Timely Mental Health Care Is a Key Factor in Strike by Kaiser Permanente Workers
A new California law requires timely follow-up appointments for mental health and addiction patients. But striking workers at Kaiser Permanente in Northern California say patients continue to wait up to two months.
By Bernard J. Wolfson and Zinnia Finn -
No-Bid Medicaid Contract for Kaiser Permanente Is Now California Law, but Key Details Are Missing
California Gov. Gavin Newsom signed a bill last month that authorizes a statewide Medicaid contract for HMO giant Kaiser Permanente. But details still need to be worked out in a memorandum of understanding.
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Battle Lines Are Drawn Over California Deal With Kaiser Permanente
A controversial proposal to grant HMO giant Kaiser Permanente a no-bid statewide Medicaid contract is headed for its first legislative hearing amid vocal opposition from a coalition of counties, competing health plans, community clinics, and a national health care labor union.
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California Inks Sweetheart Deal With Kaiser Permanente, Jeopardizing Medicaid Reforms
The backroom deal with politically connected Kaiser Permanente, which infuriated other Medi-Cal health plans, allows the health care giant to continue selecting the enrollees it wants.
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Call Centers Replaced Many Doctors’ Receptionists. Now, AI Is Coming for Call Centers.
Artificial intelligence products with lifelike voices are being marketed to schedule or cancel medical visits, refill prescriptions, and help triage patients. Soon, many patients might initiate contact with the health system by speaking not with a human but with AI.
By Darius Tahir -
Medicare Advantage Company Pays $342M to Government in Midst of Billing Probe
The payment by Elevance Health to the Centers for Medicare & Medicaid Services comes as the agency threatened to bar new enrollments in the company’s plans.
By Fred Schulte -
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 -
To Patients, Parents, and Caregivers, Proposed Medicaid Cuts Are a Personal Affront
At a town hall in Orange County, California, angry residents said Congress should keep its hands off Medicaid. The cuts contemplated in a House budget blueprint would bore a giant hole in California’s version of the safety net health insurance program, Medi-Cal, which covers nearly 15 million residents.
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Trump’s Personnel Agency Is Asking for Federal Workers’ Medical Records
The administration is asking insurers that cover federal employees and retirees to hand over details about their medical visits, their pharmacy claims, and more.
By Amanda Seitz and Maia Rosenfeld -
Doctors Increasingly See AI Scribes in a Positive Light. But Hiccups Persist.
Patients say they find AI summaries of doctor visits user-friendly, but it’s not clear if their appointments are improving. In any case, doctors appear to be embracing the high-tech innovation.
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Trump and Kennedy Seek To Relax Safeguards for AI Healthcare Tools
For years, the Department of Health and Human Services built standards to make sure electronic health records were user-friendly and offered transparent advice to doctors. Now they’re relaxing those standards, and doctors and critics in the hospital industry are worried.
By Darius Tahir -
California’s Much-Touted IVF Law May Be Delayed Until 2026, Leaving Many in the Lurch
California lawmakers are poised to approve a six-month delay in implementing the state’s in vitro fertilization law, pushing its start to January 2026. The plan to postpone, which has drawn little attention, is part of the state budget package and has left patients, insurers, and employers in limbo.
By Sarah Kwon -
If Lawsuit Ends Federal Mandates on Birth Control Coverage, States Will Have the Say
An ongoing lawsuit aims to set aside the Affordable Care Act’s requirements that insurers cover preventive care, such as contraception. If that happens, state reproductive health laws — varying across the country — would carry more weight, resuming the “wild West” dynamic from before Obamacare.
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After Chiding Democrats on Transgender Politics, Newsom Vetoes a Key Health Measure
California Gov. Gavin Newsom vetoed a bill that would have expanded access to hormone therapy, a top priority for the trans community. Advocates say it would have ensured continuity in gender-affirming care amid Trump administration attacks. Analysts say it’s another sign of the Democrat’s move to the center.
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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 -
Perspective
Surprise Medical Bills Were Supposed To Be a Thing of the Past. Surprise — They’re Not.
The No Surprises Act, which was signed in 2020 and took effect in 2022, was heralded as a landmark piece of legislation that would protect people who had health insurance from receiving surprise medical bills. And yet bills that take patients by surprise keep coming.
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The Market Forces Quietly Adding Thousands to Patient Bills
The true cost of “vertical integration”: patients directed to a higher-priced location for procedures. Or forced to buy from their insurer’s wholly owned pharmacy, which may not stock the drug prescribed or provide it at the lowest price.