Category: Health Industry

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.

Readers Offer Solo Agers Support and Reflect on Ancestors

KFF Health News gives readers a chance to comment on a recent batch of stories.

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.

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.

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.

How a Duty To Spend Wisely on Worker Benefits Could Loosen PBMs’ Grip on Drug Prices

As criticism of pharmacy benefit managers heats up, fear of lawsuits is driving some big employers to drop the “Big Three” PBMs — or force them to change.

Helicopters Rescued Patients in ‘Apocalyptic’ Flood. Other Hospitals Are at Risk, Too.

The helicopter evacuation of 70 people from a Tennessee hospital during Hurricane Helene is considered a success story. The building was destroyed by floodwaters, but no one died. In hindsight, why was it built next to a river?

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.

KFF Health News’ ‘What the Health?’: A Killing Touches Off Backlash Against Health Insurers

The 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.

Former Montana Health Staffer Rebukes Oversight Rules as a Hospital ‘Wish List’

The push-pull in Montana reflects a national tension as states try to decide what counts as fair checks on tax-exempt hospitals and industry players weigh in. The debate centers on whether nonprofit hospitals do enough good to earn their charitable status.