#medicare-advantage

#medicare-advantage

CMS officials said the proposal is intended to improve the accuracy of payments and simplify the billing system. We do not want risk adjustment to be a source of competitive advantage for health plans, Chris Klomp, CMS deputy administrator and director of Medicare, told the Journal. Medicare Advantage is a major revenue driver for insurers and federal payment policies can have substantial financial impacts. The proposed 0.09% increase would translate to roughly $700 million in additional payments across the industry, the report said.

Through the generations, hundreds of thousands of public servants have spent the best years of their lives delivering for New York whether on the beat as a cop, on the job as a firefighter, picking up trash for the Sanitation Department, pruning trees for the Parks Department, assisting seniors at the Department for the Aging, and so on.

Affiliates of Kaiser Permanente, the healthcare consortium headquartered in Oakland, have agreed to pay $556 million to resolve allegations that they violated the federal False Claims Act by submitting invalid diagnosis codes for their Medicare Advantage Plan enrollees in order to receive higher payments from the government. The civil settlement includes the resolution of certain claims brought in lawsuits under the whistleblower provisions of the False Claims Act by Ronda Osinek and Dr. James M. Taylor, former employees of Kaiser Permanente.

SAN FRANCISCO Kaiser Permanente affiliates will pay $556 million to settle a lawsuit that alleged the health care giant committed Medicare fraud and pressured doctors to list incorrect diagnoses on medical records to receive higher reimbursements, federal prosecutors said. The deal announced Wednesday came more than four years after the U.S. Department of Justice filed the legal claim in San Francisco that consolidated allegations made in six whistleblower complaints.

According to one expert at Pitchbook, two core issues are likely to dominate healthcare reform discussions in 2026: rising costs and flaws in Medicare Advantage. Healthcare affordability remains a major systemic issue preventing millions of Americans from accessing care, and Medicare Advantage's risk-adjustment system is "clearly broken," creating incentives that pull excess money into the program, explained Brian Wright, lead analyst for healthcare research at Pitchbook.

In 2025, we whiffed. You would have been wise to bet the anti-portfolio. While we (always 😂) think some of our predictions may still come true, an honest grading says we were Jets/Mets-like: just two out of 10. We nailed more payor CEOs losing their jobs (Andrew Witty and Lois Quam) and cell therapy coming back into fashion (four acquisitions, notably Capstan by Abbvie at $2.1B).

Low or $0 premiums plus supplemental benefits that traditional Medicare is not authorized by Congress to cover - dental, vision and hearing care - have attracted increasing numbers of seniors. The many disadvantages, including the need to get preauthorization for procedures or medicines your doctor has prescribed or the narrow group of health professionals that are in-network in many MA plans, are not mentioned in advertisements by brokers hired to recruit members.

Medicare Advantage enrollment jumped 32% year over year to 106,323 members, the clearest sign that Clover's technology-first model is resonating with both brokers and beneficiaries. Revenue growth of 34% from the prior year quarter underscores how scale is driving top-line expansion. What matters here is that the company achieved this growth during what management called a "3.5 star payment year," meaning reimbursement rates were compressed. That's a meaningful distinction.

Advocates for New York City retirees are preparing to rally at City Hall on Tuesday to push for a local law that would preserve the healthcare they and their families depend on. The rally is part of ongoing efforts to stop Mayor Eric Adams' attempts to switch the city's quarter-million retired municipal workers to a private Medicare Advantage plan. What makes this protest interesting is that it will occur a day after Adams' 65th birthday, Sept. 1.