News
To avoid care disruptions, know when the clock runs out on your prior authorization
7+ hour, 16+ min ago (1272+ words) Insurers require prior authorizations for certain treatments or tests, especially costly ones. A woman with multiple sclerosis wanted to be able to walk up the stairs at home without losing her balance. Her doctor prescribed medicine that helped, but then…...
Sick of fighting insurers, hospitals offer their own Medicare Advantage plans
1+ mon, 1+ week ago (1187+ words) Although hospital-owned plans are only a sliver of the Medicare Advantage market, their enrollment continues to grow, reflecting the overall increase in Advantage members. Ever since Larry Wilkewitz retired more than 20 years ago from a wood products company, he's had…...
These 3 policy moves are likely to change healthcare for older people
1+ mon, 1+ week ago (1388+ words) As with environmental law and consumer protections, the Trump administration's enthusiasm for deregulation has undone long-sought rules to improve care for the aged. Month after month, Patricia Hunter and other members of the Nursing Home Reform Coalition logged onto video…...
Kaiser Permanence to pay $556 million in record Medicare Advantage fraud settlement
1+ mon, 2+ week ago (820+ words) In the largest Medicare Advantage fraud settlement to date, Kaiser Permanente has agreed to pay $556 million to settle Justice Department allegations that it billed the government for medical conditions patients didn't have. The settlement, announced Jan. 14, resolves whistleblower lawsuits that…...
TBWA\WorldHealth folding after strategic review; CEO Robin Shapiro departing Omnicom
7+ mon, 2+ week ago (486+ words) TBWA\WorldHealth is merging into other Omnicom Health agencies following a strategic review. An Omnicom spokesperson confirmed that the 2025 MM+M Agency 100 honoree will soon be folded into sibling Omnicom Health units. "Omnicom has decided to merge TBWA\WorldHealth into…...
Trump's DOJ accuses Medicare Advantage insurers of paying 'kickbacks' for primo customers
9+ mon, 1+ week ago (929+ words) A blockbuster lawsuit filed May 1 by the federal Department of Justice alleges that insurers Aetna, Elevance Health (formerly Anthem), and Humana paid "hundreds of millions of dollars in kickbacks" to large insurance brokerages " eHealth, GoHealth, and SelectQuote. When people call…...
When hospitals ditch Medicare Advantage plans, thousands of members get to leave, too
10+ mon, 5+ day ago (1036+ words) Although disputes between health systems and insurers happen all the time, members are usually locked into their plans for the year and restricted to a network of providers, even if that network shrinks. For several years, Fred Neary had been…...
Dr. Oz evangelizes MAHA agenda at Senate confirmation hearing
11+ mon, 3+ week ago (1015+ words) Oz appears set to join HHS Secretary Robert F. Kennedy Jr. as part of Trump's public health team. In a highly anticipated confirmation hearing to lead the Centers for Medicare and Medicaid Services, Dr. Mehmet Oz said President Donald Trump wants…...
UnitedHealth wins ruling over $2B in alleged Medicare Advantage overpayments
11+ mon, 4+ week ago (765+ words) The civil fraud case against UnitedHealth Group, the nation's largest Medicare Advantage insurer, was filed in 2011. The Justice Department's years-long court battle to force UnitedHealth Group to return billions of dollars in alleged Medicare Advantage overpayments hit a major setback…...