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.
CMS
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Obamacare Sign-Ups Lag After Trump Election, Legal Challenges
The number of new and returning enrollees using healthcare.gov — the federal marketplace that serves 31 states — is well below last year’s as of early December. Also, a Biden administration push to give “Dreamers” access to Obamacare coverage and subsidies is facing court challenges.
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Georgia’s Work Requirement Slows Processing of Applications for Medicaid, Food Stamps
Georgia’s ability to process applications for Medicaid and other public benefits has lagged since the launch of Republican Gov. Brian Kemp’s “Pathways” Medicaid work requirement, leaving Georgia with persistently slow Medicaid application processing times.
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Journalists Dish on New Weight Loss Drugs, RFK Jr.’s Fluoride Claims, and Reproductive Health
KFF Health News staffers and contributors made the rounds on national and local media this week to discuss their stories. Here’s a collection of their appearances.
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Anti-Fraud Efforts Meet Real-World Test During ACA Enrollment Period
The federal government put guardrails in place to limit unauthorized plan sign-ups and switches. But the changes could prove to be a burden to consumers.
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Journalists Reflect on Trump Picks, Racism and Public Health, and Unnecessary Dental Implants
KFF Health News staff made the rounds on national and local media in the last two weeks to discuss topical stories. Here’s a collection of their appearances.
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Readers Embrace ‘Going It Alone’ Series on Aging and Chastise Makers of Pulse Oximeters
KFF Health News gives readers a chance to comment on a recent batch of stories.
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TV’s Dr. Oz Invested in Businesses Regulated by Agency Trump Wants Him To Lead
Celebrity doctor Mehmet Oz recently held broad investments in health care, tech, and food companies. Were he confirmed to run the Centers for Medicare & Medicaid Services, his job would involve interacting with giants of the industry that have contributed to his wealth.
By Darius Tahir Trump’s Nontraditional Health Picks
Episode 373Not only has President-elect Donald Trump chosen prominent vaccine skeptic Robert F. Kennedy Jr. to lead the Department of Health and Human Services, Trump also has said he will nominate controversial TV host Mehmet Oz to run the Centers for Medicare & Medicaid Services, which oversees coverage for nearly half of Americans. Meanwhile, the lame-duck Congress is back in Washington with just a few weeks to figure out how to wrap up work for the year. Rachel Cohrs Zhang of Stat, Sandhya Raman of CQ Roll Call, and Riley Ray Griffin of Bloomberg News join KFF Health News’ Julie Rovner to discuss these stories and more. Also this week, Rovner interviews Sarah Varney, who has been covering a trial in Idaho challenging the lack of medical exceptions in that state’s abortion ban.
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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 -
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 -
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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 -
Rural NC County Is Set To Reopen Its Shuttered Hospital With Help From a New Federal Program
One rural North Carolina county is on track to be among the first where a hospital reopens owing to a new federal hospital classification meant to help save small, struggling facilities.
By Taylor Sisk -
ACA Enrollment Platforms Suspended Over Alleged Foreign Access to Consumer Data
Federal regulators provided more specifics about why they suspended two private sector Affordable Care Act enrollment sites, including concerns about potential overseas accessing of consumer data and suspicions of involvement in Obamacare enrollment and switching schemes. The companies reject the assertions.
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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