News
Government Watchdog Agency Finds that Every High-Risk Acute Stroke Diagnosis Submitted by Medicare Advantage Insurers in Audit Was Upcoded
3+ hour, 2+ min ago (655+ words) HEALTH CARE un-covered Government Watchdog Agency Finds that Every High-Risk Acute Stroke Diagnosis Submitted by Medicare Advantage Insurers in Audit Was Upcoded A new federal audit found Medicare Advantage insurers received hundreds of millions in taxpayer dollars for stroke diagnoses…...
AI Gatekeepers in Medicare: WISe R Model Draws Fire for Delays and Denials
1+ mon, 2+ day ago (259+ words) A deep dive into prior authorization's toll " from doctors to federal policy"featuring Dr. Wendy Dean, Dr. Seth Glickman and Rep. Suzan Del Bene (D-WA) on CMS's new AI-driven WISe R model. Thanks for reading HEALTH CARE un-covered! This post…...
Introducing The Health Insurance Influence Tracker
1+ mon, 2+ week ago (175+ words) Today, the Center for Health and Democracy Education Fund is launching a new tool, the Health Insurance Influence Tracker, as part of our ongoing work examining how giant health insurers have skewed the U. S. health care system away from working people…...
WSJ's Editorial Board Contradicts What Its Newsroom Has Reported on Medicare Advantage
1+ mon, 3+ week ago (742+ words) The paper that exposed Medicare Advantage's $50 billion overbilling scheme is now urging the government to make it the default for every senior in America. During my two decades working for Big Insurance, I learned what industry spin looks like. I…...
CMS's Big Bump to 2027 Medicare Advantage Rate Notice Makes Wall Street Smile
1+ mon, 3+ week ago (391+ words) Just minutes after the New York Stock Exchange closed yesterday afternoon, the Trump administration announced that it will pay private Medicare Advantage insurers billions of dollars more next year than it had suggested just a few months ago. Trump's Centers…...
Catholic Nuns Are Suing United Health Group
2+ mon, 2+ day ago (484+ words) United Health Group " the nation's largest health insurer and one of the most sprawling corporate empires in American history " has spent years building a health care monopoly hiding in plain sight. Now it's trying to make sure its own shareholders…...
Senate Judiciary: United Health Turned Medicare Advantage Risk Adjustment Into a Profit Engine
4+ mon, 4+ day ago (507+ words) HEALTH CARE un-covered Senate Judiciary: United Health Turned Medicare Advantage Risk Adjustment Into a Profit Engine A Senate report reveals how risk adjustment became a business model " and one of Medicare Advantage's original champions is now warning it's gone off…...
Downcoding is Back From the Dead: Insurers Resurrected a Scheme to Pay Doctors Less That the Courts Banned
7+ mon, 2+ week ago (575+ words) Nilsa Cruz, the patient advocate at the Milwaukee Rheumatology Center, has won national awards for fighting Big Insurance practices that hamper care " frequently taking her cases to the state capitol in Madison. But for Cruz, a recent move by the…...