Tag: Medicare

Health Care Inc.: Preventive care ruling, UnitedHealth and Medicare Advantage

Health Care Inc.: Preventive care ruling, UnitedHealth and Medicare Advantage

Bob Herman covers health insurance, government programs, hospitals, physicians, and other providers — reporting on how money influences…

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Key Medicare Advantage player pivots from artery testing to bitcoin

Key Medicare Advantage player pivots from artery testing to bitcoin

Semler Scientific, a company known for marketing a device called QuantaFlo that detects artery blockages in older Americans,…

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5 Timely Ideas To Improve Medicare Advantage

5 Timely Ideas To Improve Medicare Advantage

Dr. Mehmet Oz was recently appointed as the Administrator of the Centers for Medicare & Medicaid Services (CMS)…

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Humana boosting wellness visits for Medicare Advantage profits

Humana boosting wellness visits for Medicare Advantage profits

Humana's Strategy for Boosting Medicare Advantage Profitability A central theme in Humana’s plan for boosting Medicare Advantage profitability…

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Time For Medicare Advantage Leaders—Including Me—To Eat Our Own Cooking

Time For Medicare Advantage Leaders—Including Me—To Eat Our Own Cooking

As leaders in the healthcare industry, it is crucial for us to truly understand the experiences of the…

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Health Insurers Call Out Trump On Promise To Not Cut Seniors’ Medicare

Health Insurers Call Out Trump On Promise To Not Cut Seniors’ Medicare

The nation’s health insurance companies are up in arms over proposed legislation in Congress that they say would…

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Eliminating Waste, Fraud, and Abuse in Medicaid My Administration has been relentlessly committed to rooting out waste, fraud, and abuse in Government programs to preserve and protect them for those who rely most on them. The Medicaid program was designed to be a program to compassionately provide taxpayer dollars to healthcare providers who offer care to the most vulnerable Americans. To keep payments reasonable, billable costs for such care were historically capped at the same level that healthcare providers could receive from Medicare. The State and Federal Governments jointly shared this cost burden to ensure those of lesser means did not go untreated. Under the Biden Administration, States and healthcare providers were permitted to game the system. For example, States “taxed” healthcare providers, but sent the same money back to them in the form of a “Medicaid payment,” which automatically unlocked for healthcare providers an additional “burden-sharing” payment from the Federal Government. Through this gimmick, the State could avoid contributing money toward Medicaid services, meaning the State no longer had a reason to be prudent in the amount of reimbursement provided. Instead of paying Medicare rates, many States that utilize these arrangements now pay the same healthcare providers almost three times the Medicare amount, a practice encouraged by the Biden Administration. These State Directed Payments have rapidly accelerated, quadrupling in magnitude over the last 4 years and reaching 0 billion in 2024 alone. This trajectory threatens the Federal Treasury and Medicaid’s long-term stability, and the imbalance between Medicaid and Medicare patients threatens to jeopardize access to care for our seniors. I pledged to protect and improve these important Government healthcare programs for those that rely on them. Seniors on Medicare and Medicaid recipients both deserve access to quality care in a system free from the fraud, waste, and abuse, that enriches the unscrupulous and jeopardizes the programs themselves. We will take action to continue to love and cherish the Medicare and Medicaid programs to ensure they are preserved for those who need them most. The Secretary of Health and Human Services shall therefore take appropriate action to eliminate waste, fraud, and abuse in Medicaid, including by ensuring Medicaid payments rates are not higher than Medicare, to the extent permitted by applicable law. This memorandum is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person. DONALD J. TRUMP

Eliminating Waste, Fraud, and Abuse in Medicaid My Administration has been relentlessly committed to rooting out waste, fraud, and abuse in Government programs to preserve and protect them for those who rely most on them. The Medicaid program was designed to be a program to compassionately provide taxpayer dollars to healthcare providers who offer care to the most vulnerable Americans. To keep payments reasonable, billable costs for such care were historically capped at the same level that healthcare providers could receive from Medicare. The State and Federal Governments jointly shared this cost burden to ensure those of lesser means did not go untreated. Under the Biden Administration, States and healthcare providers were permitted to game the system. For example, States “taxed” healthcare providers, but sent the same money back to them in the form of a “Medicaid payment,” which automatically unlocked for healthcare providers an additional “burden-sharing” payment from the Federal Government. Through this gimmick, the State could avoid contributing money toward Medicaid services, meaning the State no longer had a reason to be prudent in the amount of reimbursement provided. Instead of paying Medicare rates, many States that utilize these arrangements now pay the same healthcare providers almost three times the Medicare amount, a practice encouraged by the Biden Administration. These State Directed Payments have rapidly accelerated, quadrupling in magnitude over the last 4 years and reaching $110 billion in 2024 alone. This trajectory threatens the Federal Treasury and Medicaid’s long-term stability, and the imbalance between Medicaid and Medicare patients threatens to jeopardize access to care for our seniors. I pledged to protect and improve these important Government healthcare programs for those that rely on them. Seniors on Medicare and Medicaid recipients both deserve access to quality care in a system free from the fraud, waste, and abuse, that enriches the unscrupulous and jeopardizes the programs themselves. We will take action to continue to love and cherish the Medicare and Medicaid programs to ensure they are preserved for those who need them most. The Secretary of Health and Human Services shall therefore take appropriate action to eliminate waste, fraud, and abuse in Medicaid, including by ensuring Medicaid payments rates are not higher than Medicare, to the extent permitted by applicable law. This memorandum is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person. DONALD J. TRUMP

MEMORANDUM FOR THE SECRETARY OF HEALTH AND HUMAN SERVICES THE ADMINISTRATORS OF THE CENTERS FOR MEDICARE AND MEDICAID…

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Medicare seeks lower prices for drugs, including Ozempic : Shots

Medicare seeks lower prices for drugs, including Ozempic : Shots

Medicare has started price negotiations for 15 medicines, including the diabetes drug Ozempic. Mario Tama/Getty Images hide caption…

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Amazon, A Small Pharmacy Player, Seeks To Dent CVS And Walgreens Medicare Share

Amazon, A Small Pharmacy Player, Seeks To Dent CVS And Walgreens Medicare Share

Amazon Pharmacy Enhances Services for Seniors with Medicare Coverage Amazon Pharmacy is making strides to attract more seniors…

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Delaying Medicare enrollment. What to know

Delaying Medicare enrollment. What to know

As you approach the age of 65, the decision of when to enroll in Medicare can be a…

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What Medicare doesn’t pay for becomes hefty debt for millions of seniors

What Medicare doesn’t pay for becomes hefty debt for millions of seniors

Connie Morton, a resident of Colonial Beach, Va., faced a devastating loss when her husband passed away last…

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What Health Systems That Are ‘Losing On Medicare Advantage’ Can Do

What Health Systems That Are ‘Losing On Medicare Advantage’ Can Do

Medicare Advantage is often seen as a challenging program, with providers expressing frustrations over inadequate payments and financial…

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