Members of Congress reintroduced the Medicare Economic Security Solutions Act, proposing sweeping reforms to Medicare Part B late enrollment penalties. The legislation would limit penalties to 15% of the monthly premium and restrict their duration while also removing penalties for individuals who delayed enrollment due to other coverage, such as COBRA, retiree plans, or Veterans Affairs benefits. More than 700,000 Medicare beneficiaries currently face permanent increases in their Part B premiums because of late enrollment, with average penalties reaching 30%.
President Donald Trump has quietly commuted the sentence of a Florida health care executive convicted of leading a Medicare fraud scheme to pilfer $205 million from the program through false means — even as the GOP claims that their massive cuts to Medicare, Medicaid, and other programs are aimed at weeding out 'waste, fraud and abuse.'
Donald Trump publicly resisted Medicaid cuts — until his budget director, Russell Vought, convinced the president that reductions to heath coverage for low-income people, embedded in the Republican tax bill, were just weeding out fraud and abuse. Trump has readily adopted that rhetoric, repeatedly declaring that his signature bill contains 'no cuts' to the social safety program, even as the non-partisan CBO estimates at least 7.6 million people would become uninsured if the bill takes effect. Republicans are betting they can win the semantic — and thus the political — battle over the future of Medicaid.
The Nebraska Legislature passed the Ensuring Transparency in Prior Authorization Act last week which is now headed to Governor Jim Pillen for approval. According to the Nebraska Hospitals Association, this will strengthen the framework for insurance companies to follow.
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 DOJ. Stephen Hemsley's remarks during the company's annual shareholder meeting this week signal a noteworthy shift: UnitedHealth is now publicly acknowledging potential issues with how it assesses the health of its Medicare Advantage members.
Drug price middlemen are going to court to fight a first-in-the-nation effort to police their ownership of retail pharmacies as more state legislatures and Congress crank up scrutiny of their influence on the cost of medicines.