Category: medicare advantage
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STAT+: CMS halts enrollment in Elevance’s Medicare Advantage plans, citing years of misconduct
STAT+: CMS halts enrollment in Elevance’s Medicare Advantage plans, citing years of misconduct Elevance Health will no longer be able to enroll people into its Medicare Advantage plans starting March 31, according to a new, harshly worded suspension notice from the Centers for Medicare and Medicaid Services. CMS is imposing the punishment after Elevance failed…
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STAT+: Medicare Advantage growth dwindles for a second straight year
STAT+: Medicare Advantage growth dwindles for a second straight year The Medicare Advantage program continues to bring in more older adults and people with disabilities, but not nearly at the same rates from just a few years ago. Almost 35.5 million people were enrolled in a Medicare Advantage plan as of Feb. 1, up roughly…
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STAT+: Trump administration signals there’s widespread desire to curb Medicare Advantage
STAT+: Trump administration signals there’s widespread desire to curb Medicare Advantage Health insurers have endured a litany of problems with Medicare Advantage over the past three years. They were optimistic things would turn around with the Trump administration in charge. Tough luck, for now. The administration stunned Medicare Advantage insurers and their investors by proposing…
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STAT+: UnitedHealth limps into 2026 with a smaller business and fresh challenges
STAT+: UnitedHealth limps into 2026 with a smaller business and fresh challenges UnitedHealth Group enters 2026 limping financially after one of the most turbulent years in the company’s history, but executives at the health insurance and services giant made it clear they will cut their way to higher profits. On Tuesday, UnitedHealth said revenue would…
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STAT+: HHS spending bill caught up in ICE debate
STAT+: HHS spending bill caught up in ICE debate You’re reading the web edition of D.C. Diagnosis, STAT’s twice-weekly newsletter about the politics and policy of health and medicine. Sign up here to receive it in your inbox on Tuesdays and Thursdays. To those in the path of this winter storm: Are you rethinking dry January yet?…
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STAT+: UnitedHealth has turned Medicare Advantage coding into ‘profit-centered strategy,’ Senate report finds
STAT+: UnitedHealth has turned Medicare Advantage coding into ‘profit-centered strategy,’ Senate report finds UnitedHealth Group’s colossal size has helped the conglomerate turn the way patients are coded in the Medicare Advantage program into “a major profit-centered strategy, which was not the original intent of the program,” according to a new report released Monday from the…
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STAT+: UnitedHealth proclaims audits show it has ‘robust’ procedures, in contrast to findings of independent reviews
STAT+: UnitedHealth proclaims audits show it has ‘robust’ procedures, in contrast to findings of independent reviews UnitedHealth Group said Friday that the consultants it hired to audit its operations, including its practice of applying lucrative diagnosis codes to older adults’ records, found they’re not only “robust,” but “industry leading.” While the reports give a veneer…
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STAT+: Medicare Advantage plans to gain $13 billion under Trump changes to star ratings
STAT+: Medicare Advantage plans to gain $13 billion under Trump changes to star ratings Medicare Advantage insurers scored a Thanksgiving gift, as President Trump’s Medicare agency added back a bonus system that rewards health plans with consistently high marks. The Centers for Medicare and Medicaid Services also is proposing to eliminate a dozen star ratings…
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STAT+: Major health insurers like Humana, UnitedHealth are cutting broker commissions to avoid costly Medicare enrollees
STAT+: Major health insurers like Humana, UnitedHealth are cutting broker commissions to avoid costly Medicare enrollees Major health insurers are taking drastic steps to discourage older adults from signing up for their private Medicare plans as they seek to boost profits, drawing the ire of insurance brokers and state regulators. Humana, UnitedHealthcare, Anthem, and Centene,…
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STAT+: Medicare premiums to jump 10% heading into 2026
STAT+: Medicare premiums to jump 10% heading into 2026 Most Medicare enrollees will face premiums that are 10% higher next year, creating budget anxiety for millions of seniors. Older adults and people with disabilities will pay almost $203 per month in 2026 for their Medicare Part B premium, the Trump administration said late Friday. That’s…
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STAT+: UnitedHealthcare drops remote monitoring coverage in defiance of Medicare policies
STAT+: UnitedHealthcare drops remote monitoring coverage in defiance of Medicare policies Beginning in January, UnitedHealthcare will no longer pay physicians to remotely monitor the data that patients collect at home about chronic conditions like hypertension. The updated medical policies for both Medicare and commercial health plans from the country’s largest insurer were posted in September…
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STAT+: UnitedHealth wants to employ more of its doctors
STAT+: UnitedHealth wants to employ more of its doctors After assembling the largest collection of doctors in the U.S., UnitedHealth Group is switching strategies in an effort to improve its financial performance. The company plans to revamp its enterprise of 90,000 clinicians into one more heavily weighted toward employed physicians, rather than affiliated doctors, executives…
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STAT+: Kaiser Permanente, DOJ nearing resolution in $1 billion Medicare fraud case
STAT+: Kaiser Permanente, DOJ nearing resolution in $1 billion Medicare fraud case The Justice Department and Kaiser Permanente are nearing a deal in their behind-the-scenes negotiations over the government’s claim that the California health care giant bilked Medicare out of $1 billion. The federal judge overseeing the DOJ’s long-running case against Kaiser on Friday granted…
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STAT+: Medicare Advantage insurers still in retreat as annual enrollment kicks off
STAT+: Medicare Advantage insurers still in retreat as annual enrollment kicks off Medicare Advantage has skyrocketed in popularity over the past decade, reeling in new members with zero-dollar premiums and generous benefits. But the rate of growth has slowed in recent years, and in 2026, there’s a decent chance enrollment will contract for the first…
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STAT+: Top Democrat demands more detail from Medicare insurers about their use of AI
STAT+: Top Democrat demands more detail from Medicare insurers about their use of AI Sen. Richard Blumenthal (D-Conn.) is pressing the nation’s largest Medicare Advantage insurers to provide more detail about their use of artificial intelligence tools amid reports that these companies are rapidly increasing their reliance on the technology to help make decisions about…
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STAT+: Unsealed court documents reveal a whistleblower suit over UnitedHealth use of an artery disease test
STAT+: Unsealed court documents reveal a whistleblower suit over UnitedHealth use of an artery disease test A law firm representing health care fraud whistleblowers is suing UnitedHealth Group over its use of a peripheral artery disease test, called QuantaFlo, to increase payments it received from the government Medicare program, after the Department of Justice declined…
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STAT+: CMS delays rule requiring Medicare Advantage insurers to remind members of unused benefits
STAT+: CMS delays rule requiring Medicare Advantage insurers to remind members of unused benefits Medicare is delaying implementation of a Biden-era rule that would have made Medicare Advantage plans notify members about their unused supplemental benefits — services such as vision and dental. Even though taxpayers hand health insurers more than $80 billion each year…
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STAT+: Elevance loses lawsuit over Medicare Advantage quality ratings
STAT+: Elevance loses lawsuit over Medicare Advantage quality ratings A federal judge in Texas struck down Elevance Health’s lawsuit that argued the government unfairly lowered its Medicare Advantage quality ratings — a decision that could cost Elevance $375 million in bonus revenue. U.S. District Judge Mark T. Pittman, appointed by President Trump in 2019, chastised…
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STAT+: Prasad returns to the FDA, Attack on the CDC
STAT+: Prasad returns to the FDA, Attack on the CDC You’re reading the web edition of D.C. Diagnosis, STAT’s twice-weekly newsletter about the politics and policy of health and medicine. Sign up here to receive it in your inbox on Tuesdays and Thursdays. Normally I keep the intro to this newsletter light-hearted. But today I feel compelled…
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STAT+: In health insurers’ race to offload unprofitable members, winners begin to emerge
STAT+: In health insurers’ race to offload unprofitable members, winners begin to emerge If you’ve followed health insurance earnings over the past few weeks, you might be experiencing some whiplash. Four of the biggest players — top names like UnitedHealth Group and Elevance — lowered their profit expectations for the year, while two others —…
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STAT+: Judge dismisses Humana’s case over downgraded Medicare Advantage ratings
STAT+: Judge dismisses Humana’s case over downgraded Medicare Advantage ratings A federal judge on Friday tossed out a lawsuit from Humana that attempted to reinstate higher quality ratings to its 2025 Medicare Advantage plans. The ruling jeopardizes billions of dollars in taxpayer-funded bonuses that Humana gets from the government’s star ratings program. However, Humana said…
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STAT+: Centene’s stock plummets as health insurance giant scraps 2025 financial outlook
STAT+: Centene’s stock plummets as health insurance giant scraps 2025 financial outlook Centene has withdrawn its financial guidance for the rest of the year after receiving data that showed its health insurance members in Affordable Care Act plans are getting a lot more care than the company had anticipated. The company is also seeing a…
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STAT+: Internal document shows how UnitedHealth executives prepared to tamp down investor unrest
STAT+: Internal document shows how UnitedHealth executives prepared to tamp down investor unrest An internal document drafted in advance of UnitedHealth Group’s shareholder meeting this week reveals how the company’s leadership — facing an extraordinary series of financial and legal challenges — sought to downplay complaints about its business practices and assure jittery investors that…
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STAT+: UnitedHealth conducting ‘comprehensive review’ of Medicare practices that are facing federal scrutiny, new CEO says
STAT+: UnitedHealth conducting ‘comprehensive review’ of Medicare practices that are facing federal scrutiny, new CEO says UnitedHealth Group’s new CEO told investors that the company is reevaluating how it tallies Medicare Advantage patients’ diagnoses for reimbursement purposes, an issue currently under investigation by the Justice Department. Stephen Hemsley’s remarks during the company’s annual shareholder meeting…
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STAT+: Trump, building on Biden policy, to speed up audits of Medicare Advantage insurers
STAT+: Trump, building on Biden policy, to speed up audits of Medicare Advantage insurers President Trump’s federal Medicare agency will expedite audits of Medicare Advantage insurers, a move that could claw back nearly $500 million a year for taxpayers, according to previous federal estimates. However, the audits remain mired in a two-year-old lawsuit initiated by…
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STAT+: UnitedHealth’s Optum working on Medicare risk scoring system that would use AI
STAT+: UnitedHealth’s Optum working on Medicare risk scoring system that would use AI SAN DIEGO — Optum, the health data and care provider division of UnitedHealth Group, is developing a way to calculate how sick Medicare patients are through artificial intelligence, instead of relying solely on diagnosis codes submitted by physicians. Ken Cohen, a physician…
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STAT+: Justice Department sues Medicare Advantage insurers and brokers, alleging kickbacks
STAT+: Justice Department sues Medicare Advantage insurers and brokers, alleging kickbacks The Department of Justice has sued three of the largest Medicare Advantage insurers and three dominant insurance brokerages, alleging a scheme in which the health insurers bribed the brokers to steer older adults into their policies. The lawsuit targets CVS Health’s Aetna, Elevance Health’s…
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STAT+: RFK Jr.’s Senate hearing delayed, living with more measles
STAT+: RFK Jr.’s Senate hearing delayed, living with more measles You’re reading the web edition of D.C. Diagnosis, STAT’s twice-weekly newsletter about the politics and policy of health and medicine. Sign up here to receive it in your inbox on Tuesdays and Thursdays. STAT is cutting the price of an annual subscription in half. Click here for…
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STAT+: Study shows how UnitedHealth uses coding to rake in extra cash from Medicare Advantage
STAT+: Study shows how UnitedHealth uses coding to rake in extra cash from Medicare Advantage Health insurers in the private Medicare business have a big incentive to diagnose their members with lots of health conditions: The government pays them more money. A new study shows the extent to which the biggest player in that business,…
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STAT+: Trump gives major lift to 2026 Medicare Advantage payments
STAT+: Trump gives major lift to 2026 Medicare Advantage payments Health insurers that sell Medicare Advantage plans are going to get about $30 billion more in taxpayer money next year. President Trump’s Medicare agency finalized a rule Monday that would raise benchmark payment rates to privatized Medicare plans by 5.1% for 2026. That was higher…
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Senate confirms Oz as head of agency that runs Medicare, Medicaid
Senate confirms Oz as head of agency that runs Medicare, Medicaid WASHINGTON — In a party-line vote of 53-45, the Senate on Thursday confirmed Mehmet Oz to lead the Centers for Medicare and Medicaid Services. Oz’s confirmation was expected; he is not as controversial as Health and Human Secretary Robert F. Kennedy Jr. or some…