Category: Medicare Advantage

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.

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.

KFF Health News’ ‘What the Health?’: Trump’s Nontraditional Health Picks

Not 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.

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.

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.

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.

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.

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.

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.

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.