Author: Avisoscuba
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A western New York health insurance provider for seniors and the CEO of its medical analytics arm have agreed to pay a total of up to $100 million to settle Justice Department allegations of fraudulent billing for health conditions that were exaggerated or didn’t exist. Independent Health Association of Buffalo, which operates two Medicare Advantage plans, will pay up to $98 million. Betsy Gaffney, CEO of medical records review company DxID, will pay $2 million, according to the settlement agreement. Neither admitted wrongdoing. “Today’s result sends a clear message to the Medicare Advantage community that the United States will take…
Elisabeth Rosenthal Over 6½ years ago, KFF Health News and NPR kicked off “Bill of the Month,” a crowdsourced investigation highlighting the impact of medical bills on patients. The goal was to understand how the U.S. health care system generates outsize bills and to empower patients with strategies to avoid them. We asked readers and listeners to submit their bills — and they kept coming. “Bill of the Month” has received nearly 10,000 submissions, each a picture of a health system’s dysfunction and the financial burden it places on the patients. Since 2018, we have analyzed bills totaling almost $6.3…
It seems simple: Require hospitals and insurers to post their negotiated prices for most health care services and — bingo — competition follows, yielding lower costs for consumers. But nearly four years after the first Trump administration’s regulations forced hospitals to post massive amounts of pricing information online, the effect on patients’ costs is unclear. And while President Joe Biden added requirements to make pricing information more user-friendly, Donald Trump’s imminent return to the White House has raised questions about what’s next, even though posting prices is an area of rare bipartisan agreement. The uncertainty of what might happen next…
Keith Poulsen’s jaw dropped when farmers showed him images on their cellphones at the World Dairy Expo in Wisconsin in October. A livestock veterinarian at the University of Wisconsin, Poulsen had seen sick cows before, with their noses dripping and udders slack. But the scale of the farmers’ efforts to treat the sick cows stunned him. They showed videos of systems they built to hydrate hundreds of cattle at once. In 14-hour shifts, dairy workers pumped gallons of electrolyte-rich fluids into ailing cows through metal tubes inserted into the esophagus. “It was like watching a field hospital on an active…
Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names. Solo Agers, Join the Crowd! Enjoyed your panel discussion (Watch: ‘Going It Alone’ — A Conversation About Growing Old in America, Dec. 12). I am 85, retired at 55. Traveled (birding) in 65 countries. In 2010, I created the First Friday Ideas Salon. We just had our 171st gathering, via Zoom. I curate each gathering. Last month, we hosted a conservator and a scientist from the Getty museum. The month before: a Cal Tech professor on…
The Host After weeks of painstaking negotiations, Democrats and Republicans in the House and Senate agreed to a major year-end package of health bills, including new regulations for drug companies and pharmacy benefit managers, and renewals of programs to combat opioid abuse and prepare for the next possible pandemic. But the effort could be all for naught, as President-elect Donald Trump and his government-cutting adviser, Elon Musk, complained it gave Democrats too much of what they wanted and threatened Republicans who might vote for it with challenges in upcoming primary elections. Meanwhile, Texas Attorney General Ken Paxton sued a doctor…
It’s open enrollment season for the Affordable Care Act — and there are ongoing challenges. First up, enrollment. New and returning sign-ups through healthcare.gov — the federal marketplace that serves 31 states — are well below last year’s rate. New enrollments were just over 730,000 in early December, compared with 1.5 million at the same time last year. To give consumers in those states more time to enroll, the Centers for Medicare and Medicaid Services extended the deadline to Wednesday to sign up for coverage that starts Jan. 1. (Open enrollment itself ends in most states on Jan. 15, for coverage that would begin Feb. 1.) Meanwhile, the Biden administration is seeking to put…
Las nuevas inscripciones bajo la Ley de Cuidado de Salud a Bajo Precio (ACA) parecen ser hasta un millón menos que el número récord del año pasado, especialmente por problemas con el programa que enfrenta la saliente administración Biden. La reelección de Donald Trump para un segundo mandato ha generado incertidumbre sobre el futuro de la ley de salud. Además, el gobierno implementó normas complejas para reducir las inscripciones fraudulentas y está combatiendo una demanda que busca evitar que un grupo de inmigrantes sin residencia legal adquieran cobertura en los mercados de seguros de salud. Hasta ahora, el número de…
Tom Contos is an avid runner. When he started experiencing rectal bleeding in March, he thought exercise could be the cause and tried to ignore it. But he became increasingly worried when the bleeding continued for weeks. The Chicago health care consultant contacted his physician at Northwestern Medicine, who referred him for a diagnostic colonoscopy, at least partly because Contos, 45, has a family history of colon issues. “I work out a lot,” he said. “But my partner said this isn’t normal. My primary care physician said, ‘Given your family history, let’s get you in.’” Northwestern Memorial Hospital asked him…
Julie Appleby, KFF Health News New enrollments under the Affordable Care Act are on pace to trail last year’s record numbers by as many as a million as the outgoing Biden administration confronts upheavals in the program. Donald Trump’s election to a second term has cast uncertainty around the future of the health law. In addition, the Biden administration implemented cumbersome policies to reduce fraudulent enrollment and is combating a lawsuit that aims to block immigrants who lack legal residency from buying insurance under the program. So far, the number of new and returning enrollees using healthcare.gov — the federal…
Andy Miller and Renuka Rayasam and Sam Whitehead Three Democratic senators asked the country’s top nonpartisan government watchdog on Tuesday to investigate the costs of a Georgia program that requires some people to work to receive Medicaid coverage. The program, called “Georgia Pathways to Coverage,” is the nation’s only active Medicaid work requirement. Pathways has cost tens of millions in federal and state dollars on administration and consulting fees while enrolling 5,542 people as of Nov. 1, according to KFF Health News’ reporting. The congressional letter cited the reporting in its request to the Government Accountability Office. “Republicans are hell-bent…
Ann Lewandowski knows all about pharmacy benefit managers, or PBMs, the companies that shape the U.S. drug market. Her job, as a policy advocate at drugmaker Johnson & Johnson, was to tell patient and physician groups about the PBMs’ role in high drug prices. Armed with that knowledge, Lewandowski filed a potentially groundbreaking lawsuit in February. Rather than targeting the PBMs, however, she went after a big company that uses one — her own employer, Johnson & Johnson. Lewandowski charges in her lawsuit that by contracting with the PBM Express Scripts, which is part of the insurance giant Cigna, Johnson…
Among the biggest-grossing films in America in February 2002 were a war drama about American troops in Somalia (“Black Hawk Down”), an Arnold Schwarzenegger action movie (“Collateral Damage”), and a future Oscar winner about a brilliant mathematician struggling with schizophrenia (“A Beautiful Mind”). But none of these films topped the box office that month. That title went to “John Q.,” a movie about health insurance. Or, more precisely, a story about a desperate father — played by Denzel Washington — who takes a hospital emergency room hostage at gunpoint when his HMO refuses to cover a heart transplant for his…
Colorado’s new voter-approved gun initiative has a target unlike those of previous measures meant to reduce gun violence. The tax on guns and ammunition is meant to generate revenue to support cash-strapped victim services, and it’s an open question whether it will affect firearms sales. The 6.5% tax on manufacturers and sellers — including pawnbrokers — of guns, gun parts, and ammunition will generate an estimated $39 million a year. The money is aimed primarily at crime victim services, including groups that help victims of domestic violence. Some of it is earmarked for behavioral and mental health for veterans and…
Many of President-elect Donald Trump’s candidates for federal health agencies have promoted policies and goals that put them at odds with one another or with Trump’s choice to run the Department of Health and Human Services, Robert F. Kennedy Jr., setting the stage for internal friction over public health initiatives. The picks hold different views on matters such as limits on abortion, the safety of childhood vaccines, the covid-19 response, and the use of weight-loss medications. The divide pits Trump picks who adhere to more traditional and orthodox science, such as the long-held, scientifically supported findings that vaccines are safe,…
LOS ANGELES — President-elect Donald Trump’s promise of mass deportations and tougher immigration restrictions is deepening mistrust of the health care system among California’s immigrants and clouding the future for providers serving the state’s most impoverished residents. At the same time, immigrants living illegally in Southern California told KFF Health News they thought the economy would improve and their incomes might increase under Trump, and for some that outweighed concerns about health care. Community health workers say fear of deportation is already affecting participation in Medi-Cal, the state’s Medicaid program for low-income residents, which was expanded in phases to all…
LOS ÁNGELES, California.— La promesa del presidente electo Donald Trump de deportaciones masivas y restricciones migratorias más severas está aumentando la desconfianza en el sistema de salud entre los inmigrantes en California, y nublando el futuro de los proveedores que atienden a los residentes más empobrecidos del estado. Al mismo tiempo, inmigrantes que viven en el sur de California sin papeles dijeron a KFF Health News que pensaban que la economía mejoraría y que sus ingresos podrían aumentar bajo Trump. Para algunos, esa esperanza supera a sus preocupaciones sobre la atención de salud. Trabajadores comunitarios de salud dicen que el…
Tescha Hawley learned that hospital bills from her son’s birth had been sent to debt collectors only when she checked her credit score while attending a home-buying class. The new mom’s plans to buy a house stalled. Hawley said she didn’t owe those thousands of dollars in debts. The federal government did.Hawley, a citizen of the Gros Ventre Tribe, lives on the Fort Belknap Indian Reservation in Montana. The Indian Health Service is a federal agency that provides free health care to Native Americans, but its services are limited by a chronic shortage of funding and staff. Hawley’s local Indian…
In the past few years, state and local governments across the U.S. have begun spending billions in opioid settlements paid by companies accused of fueling the overdose crisis. But where is that money going, who is getting it, and is it doing any good? KFF Health News, partnering with the Johns Hopkins Bloomberg School of Public Health and Shatterproof, a national nonprofit focused on addiction, undertook a yearlong investigation to find out. Dozens of interviews, thousands of pages of documents, an array of public records requests, and outreach to all 50 states resulted in a first-of-its kind database that catalogs…
ERWIN, Tenn. — April Boyd texted her husband before she boarded the helicopter. “So, I don’t want to be dramatic,” she wrote on Sept. 27, “but we are gonna fly and rescue patients from the rooftop of Unicoi hospital.” Earlier that day, Hurricane Helene roared into the Southern Appalachian Mountains after moving north through Florida and Georgia. The storm prompted a deadly flash flood that tore through Unicoi County in eastern Tennessee, trapping dozens of people on the rooftop of the county hospital. The fast-moving floodwaters had made earlier rescue attempts by ambulance and boat impossible. Trees, trailers, buildings, caskets,…
Eloisa Mendoza ha pasado 18 años ayudando a personas que no dominan el inglés a comprender documentos legales complejos. Los guía en medio de eventos estresantes, repletos de denso papeleo, como solicitudes de ciudadanía, divorcios y traducciones de actas de nacimiento. Mendoza trabaja en Elko, Nevada, una región remota en el noreste del estado. Su labor se ha vuelto cada vez más importante a medida que la población latina de la ciudad ha crecido a aproximadamente el 26%. El porcentaje de personas de 5 años o más que hablan un idioma distinto al inglés en casa aumentó al 18% en…