5 Key Facts About Immigrants and Medicaid
This brief provides five key facts on Medicaid and immigrants as context for understanding the potential impacts of policy changes under the Trump administration.
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Kaiser Permanente To Pay $556 Million in Record Medicare Advantage Fraud Settlement
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 accused the giant health insurer of mounting a years-long scheme in which it…
AI-Driven Layoffs In Healthcare: Navigating Legal Risks and Operational Challenges
Layoffs tied to AI adoption will not be uniform; they will vary by sector, job function, and regulatory exposure. Nowhere is this more complex than in healthcare, where legal constraints, patient safety obligations, and labor dynamics intersect with rapid technological change. The post AI-Driven Layoffs In Healthcare: Navigating Legal Risks and Operational Challenges appeared first…
A deeper dive into drug revenue and cost
Many people don’t understand why pharmaceuticals cost so much money. Don’t pharmaceutical companies make a lot of money? The answer is ‘yes’, but only if the drugs are successful. A paper by Wouters et al. (2024) found that: Based on data for 361 of 558 new therapeutic agents approved over the study period (median follow-up…
Private Medicare, Medicaid Plans Exaggerate In-Network Mental Health Options, Watchdogs Say
Companies running private Medicare and Medicaid insurance plans inaccurately list many mental health professionals as being available to treat the plans’ members, a new federal watchdog report says. The investigators allege that some insurers effectively set up “ghost networks” of psychologists, psychiatrists, and other mental health professionals who purportedly have agreed to treat patients covered…
Why Kidney Care’s Biggest Investment Wave Hasn’t Moved Hospital Costs
The problem may not be the investment. It may be the target of the intervention. The post Why Kidney Care’s Biggest Investment Wave Hasn’t Moved Hospital Costs appeared first on MedCity News.
4 Notable Health Tech Funding Announcements in January
Health tech companies made several major funding announcements in January. Here is a list of some of the biggest funding rounds. The post 4 Notable Health Tech Funding Announcements in January appeared first on MedCity News.
These 3 Mindset Shifts Will Help Providers Deliver Consumer-Driven Care, Investor Says
One of the most important things providers can do on the journey toward consumer-driven care is to check their paternalism at the door, said Nworah Ayogu, head of healthcare impact at Thrive Capital. The post These 3 Mindset Shifts Will Help Providers Deliver Consumer-Driven Care, Investor Says appeared first on MedCity News.
If the Record Doesn’t Reflect the Risk, the Rating Won’t Reflect the Care
Documentation gaps can quietly undermine everything from how your organization is publicly rated, to how they are reimbursed, to how payers evaluate your performance, leading to weaker negotiating power, and decreased ability to recruit top talent or attract patients. The post If the Record Doesn’t Reflect the Risk, the Rating Won’t Reflect the Care appeared…
Medicare Advantage Insurers Deny Prior Authorization Requests for Post Acute Care at Substantially Higher Rates Than the Overall Denial Rate
Two recent reports find that Medicare Advantage organizations deny prior authorization requests for long-term care hospital, inpatient rehabilitation hospital, and skilled nursing facility stays at higher rates than requests overall. When these decisions are appealed, they are frequently overturned, particularly for skilled nursing facility stays. This may cause delays for Medicare beneficiaries who are particularly…