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#medicareadvantage

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"The Wall Street Journal said federal officials have launched a civil fraud investigation into how the company records diagnoses that lead to extra payments for its Medicare Advantage plans. Those are privately run versions of the government’s Medicare coverage program mostly for people ages 65 and over."
mprnews.org/story/2025/02/21/u

MPR News · UnitedHealth shares dive after report of U.S. investigation into Medicare billingBy The Associated Press
Continued thread

When #RFKJr first described #Medicare, he seemed to ignore the half of the program that relies on #PrivateInsurance plans to provide care. Later, he acknowledged that he was enrolled in a private #MedicareAdvantage plan.

Kennedy described #Medicaid as ”fully paid for by the federal government.” In fact, Medicaid, which provides #HealthInsurance coverage to nearly 80 million low-income Americans, is financed through a combination of state & federal funds.

All #MedicareAdvantage does is put money in the hands of #Insurance companies. There is no cost savings to elders. (See my prior posts on how MA costs more for #taxpayers.)

From MedPage -- Even though almost all Medicare Advantage (MA) plans boast coverage of supplemental benefits (dental, vision, and hearing) enrollees didn't get more care, and they spent just as much out of pocket as those with traditional #medicare a cross-sectional study showed. MA and traditional Medicare enrollees had "virtually identical" rates of using hearing aids (13.4% and 13.2%), wearing eyeglasses (78% and 76.8%), and having an eye exam in the past year (53.5% and 53.6%), according to Christopher Cai, MD, of Brigham and Women's Hospital in Boston, and colleagues.

UGH!

I have a pinched nerve in my neck causing me intense pain.

I miraculously was able (I thought) to make an appointment last week for tomorrow thru my #MedicareAdvantage #HMO with a new doctor.

They just called me.

Since I'd be a "New" patient I was told, "a 15 minute visit would not be long enough", forcing me to reschedule with a different doctor who can't see me until Jan 16th. 😞

More than two weeks. I'm in intense pain and must wait more than two weeks to see someone. 🤬

"Project 2025 has called for making #MedicareAdvantage—the privatized Medicare in which #UnitedHealth specializes—the default enrollment option for #Medicare. This would essentially privatize Medicare for the 66 million people who use it, but since Medicare Advantage costs taxpayers about 6% more than Medicare, this would not create the savings Musk is supposed to be finding."

heathercoxrichardson.substack.
#UHC

Letters from an American · December 5, 2024By Heather Cox Richardson

Read this as "introduced #AI into the process":

“Last month, the U.S. Senate Permanent Subcommittee on Investigations issued a report showing that #UnitedHealthcare rate of denying claims for post-acute care for its #MedicareAdvantage customers rose to 22.7% in 2022, from 10.9% in 2020, as the company introduced new automation into the process.”
apple.news/AkQeHqhXzQwiPotRJly

apple.newsEveryone Is Suddenly Venting Over Insurance Claim Denials. Here’s Why. — Barron’sIn the days since the murder of UnitedHealth executive Brian Thompson, insurance claim denials have become a central point of anger across America.
Replied in thread

@ThomHartmann
i’ll just leave my mom’s story here. Severe osteoporosis, many broken bones: hips, spine, etc. after breaks from falls PT: 4-6 weeks to get approval for 4-6 weeks of PT (never enough!), 8-10 weeks to get approval for more so always backslid to even worse situation before re-approval, 4-6 weeks approved (but now in worse condition), 8-10 weeks to get approval for further PT…. Rinse and repeat until she died a miserable death.
#MedicareAdvantage
#Humana
#HealthcareNot

Remembering UHC's less than timely consideration of my appeal of their denial of venue for my 86-year old mom who suffers from Alzheimer's. Clever trick: they never denied the appeal. But the clock ran out for their coverage at the hospital where she was being treated. So it was either accept the far inferior dump of a rehab facility over the superior hospital one. There's a special place in hell for these insurance company executives.

DATE: December 02, 2024 at 04:37PM
SOURCE: HEALTHCARE INFO SECURITY

Direct article link at end of text block below.

Feds Propose #ArtificialIntelligence 'Guard Rails' for #MedicareAdvantage Plans t.co/yLiXnyvUOq #CMS #HHSgov #AI #MA

Here are any URLs found in the article text:

t.co/yLiXnyvUOq

Articles can be found by scrolling down the page at healthcareinfosecurity.com/ under the title "Latest"

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Healthcare security & privacy posts not related to IT or infosec are at @HIPAABot . Even so, they mix in some infosec with the legal & regulatory information.

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#security #healthcare #doctors #itsecurity #hacking #doxxing #psychotherapy #securitynews #psychotherapist #mentalhealth #psychiatry #hospital #socialwork #datasecurity #webbeacons #cookies #HIPAA #privacy #datanalytics #healthcaresecurity #healthitsecurity #patientrecords @infosec #telehealth #netneutrality #socialengineering

t.coFeds Propose AI 'Guard Rails' for Medicare Advantage PlansThe Centers for Medicare and Medicaid Services has issued proposed "guard rails" to help ensure that the use of artificial intelligence for Medicare

"Whoops, Medicare Advantage Costs Taxpayers 22% More"

If you're a US taxpayer, thank me for not being on that shitshow that is Medicare Advantage.

I'm on Medicare. I could be on Medicare Advantage, but I passed.

It seems the only "advantage" to be found in this program is for the insurance companies.

#USHealthcare #USHealthInsurance #Medicare #MedicareAdvantage

crooksandliars.com/2024/11/who

Crooks and Liars · Whoops, Medicare Advantage Costs Taxpayers 22% MoreBy The Conversation