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.
Medicare Advantage
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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 -
Election Outcome Could Bring Big Changes to Medicare
Democrats and conservatives are divided over whether the federal health program for people over 65 should be run almost entirely by the private sector. If Trump retakes the White House, the shift to Medicare Advantage may accelerate.
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Vance Wrongly Blames Rural Hospital Closures on Immigrants in the Country Illegally
Experts disputed the claim by Republican vice presidential candidate JD Vance, noting that a range of other issues — from low reimbursement rates to declining patient use — combine to cause these facilities to shutter.
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Patients Are Relying on Lyft, Uber To Travel Far Distances to Medical Care
Uber and Lyft have become a critical part of the nation’s infrastructure for transporting ailing people from their homes — even in rural areas — to medical care sites in major cities such as Atlanta.
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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 -
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 -
A California Medical Group Treats Only Homeless Patients — And Makes Money Doing It
Healthcare in Action, a California medical group that exclusively serves homeless people, has tapped into growing demand and funding for street medicine services. Three years in, the innovative nonprofit is raking in revenue and serving thousands of people who otherwise might flock to the hospital for high-cost care.
By Angela Hart -
Biden Plan To Save Medicare Patients Money on Drugs Risks Empty Shelves, Pharmacists Say
President Joe Biden is campaigning for reelection on his efforts to cut costs for Medicare patients at the pharmacy counter. But independent pharmacists say one strategy makes it unaffordable for them to keep some brand-name medicines in stock.
By Susan Jaffe -
Your Doctor or Your Insurer? Little-Known Rules May Ease the Choice in Medicare Advantage
Disputes between hospitals and Medicare Advantage plans are leading to entire hospital systems suddenly leaving insurance networks. Patients are left stuck in the middle, choosing between their doctors and their insurance plan. There’s a way out.
By Susan Jaffe -
Readers Weigh Downsides of Medicare Advantage and Stick Up for Mary Lou Retton
KFF Health News gives readers a chance to comment on a recent batch of stories.
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Watch: Older Americans Say They Feel Stuck in Medicare Advantage Plans
You’ve probably seen advertising about Medicare Advantage plans. KFF Health News' Sarah Jane Tribble explains the pros and cons of this insurance option as enrollment in these plans increases.
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Older Americans Say They Feel Trapped in Medicare Advantage Plans
As enrollment in private Medicare Advantage plans grows, so do concerns about how well the insurance works, including from those who say they have become trapped in the private plans as their health declines.
2023 Is a Wrap
Episode 3272023 was another busy year in health care. As the covid-19 pandemic waned, policymakers looked anew at long-standing obstacles to obtaining and paying for care in the nation’s health care system. Meanwhile, abortion has continued to be an issue in much of the nation, as states respond to the Supreme Court’s 2022 decision overturning the constitutional right to the procedure. This week, Rachel Cohrs of Stat, Sandhya Raman of CQ Roll Call, and Joanne Kenen of Johns Hopkins University and Politico Magazine join KFF Health News chief Washington correspondent Julie Rovner to discuss these issues and wrap up the year in health. Also this week, Rovner interviews KFF Health News’ Jordan Rau about his joint KFF Health News-New York Times series “Dying Broke.”