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.
Insurance
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Employers Press Congress To Cement Health Price Transparency Before Trump’s Return
Donald Trump’s first administration advanced rules forcing hospitals and insurers to reveal prices for medical services. Employers don’t want to risk backtracking during Trump’s second administration.
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He Went in for a Colonoscopy. The Hospital Charged $19,000 for Two.
A man in Chicago with a troubling symptom underwent a common procedure. Then he wanted to know why the hospital charged nearly three times its own cost estimate.
By Harris Meyer -
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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Democratic Senators Ask Watchdog Agency To Investigate Georgia’s Medicaid Work Rule
A group of Democratic senators asked the Government Accountability Office to examine a Georgia program that requires some Medicaid enrollees to work, study, or volunteer 80 hours a month for coverage. They cited KFF Health News’ reporting, which has documented the program’s high costs and low enrollment.
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News Analysis
Rage Has Long Shadowed American Health Care. It’s Rarely Produced Big Change.
The outpouring of anger at health insurers following the killing of UnitedHealthcare CEO Brian Thompson continues a cycle of rage that dates back decades.
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Trump Threat to Immigrant Health Care Tempered by Economic Hopes
Donald Trump’s second term is reigniting mistrust in health services among California immigrants, making it harder for community health workers to get people enrolled in Medi-Cal. Yet the president-elect is also seen as someone who could improve their lives with a better economy, even if that means forgoing health care.
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Perspective
Removing a Splinter? Treating a Wart? If a Doctor Does It, It Can Be Billed as Surgery
Minor interventions are increasingly being rebranded and billed as surgery, for profit. This means a neurologist spending 40 minutes with a patient to tease out a diagnosis can be paid less for that time than a dermatologist spending a few seconds squirting a dollop of liquid nitrogen onto the skin.
A Killing Touches Off Backlash Against Health Insurers
Episode 376The shocking shooting death of UnitedHealthcare’s chief executive in Midtown Manhattan prompted a public outcry about the problems with the nation’s health care system, as stories of delayed and denied care filled social media. Meanwhile, President-elect Donald Trump continues to avoid providing specifics about his plans for the Affordable Care Act and other health issues. Alice Miranda Ollstein of Politico, Sandhya Raman of CQ Roll Call, and Rachel Cohrs Zhang of Stat join KFF Health News’ Julie Rovner to discuss these stories and more. Also this week, Rovner interviews Francis Collins, who was the director of the National Institutes of Health and a science adviser to President Joe Biden.
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Federal Judge Halts Dreamers’ Brand-New Access to ACA Enrollment in 19 States
A federal judge sided with 19 states seeking an injunction against a Biden administration rule allowing recipients of Deferred Action for Childhood Arrivals to enroll in Affordable Care Act coverage and qualify for subsidies amid the annual open enrollment period.
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Journalists Dig Into Vaccine Debate and America’s Obesity Rates
KFF Health News staff made the rounds on national and local media in recent weeks to discuss topical stories. Here’s a collection of their appearances.
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How Potential Medicaid Cuts Could Play Out in California
As Donald Trump prepares to reenter the White House with a Republican-controlled Congress, health officials and community advocates in California worry that large-scale Medicaid cuts could be enacted as soon as next year. More than 60% of California’s $161 billion Medi-Cal budget comes from Washington.
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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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9 States Poised To End Coverage for Millions if Trump Cuts Medicaid Funding
About 3.7 million people are at immediate risk of losing health coverage should the federal government cut funding for Medicaid expansions, as some allies of President-elect Donald Trump have proposed. Coverage could be at risk in the 40 states that have expanded Medicaid.
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A Toddler Got a Nasal Swab Test but Left Before Seeing a Doctor. The Bill Was $445.
A mom in Peoria, Illinois, took her 3-year-old to the ER one evening last December. While they were waiting to be seen, the toddler seemed better, so they left without seeing a doctor. Then the bill came.
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Florida’s Deloitte-Run Computer System Cut Off New Moms Entitled to Medicaid
Florida discovered a glitch in its Deloitte-run Medicaid eligibility system. The problem, alleged in court testimony, led to new mothers wrongly losing their insurance coverage.
By Daniel Chang and Samantha Liss -
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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