Medicare

As he takes the reins of the Senate Health, Education, Labor & Pensions Committee, the independent from Vermont maps out his strategy for negotiating with Republicans — and Big Pharma.

Kaiser Health News has released never-before-seen details of federal audits as the government weighs action against dozens of Medicare Advantage plans.

A months-long examination found gaping holes and expansive gray areas through which banned individuals slip to repeatedly bilk Medicaid, Medicare and other taxpayer-funded federal programs.

In August, Congress approved a $35 cap on what seniors will pay for insulin, but that change came too late to add to the online tool that helps Medicare beneficiaries compare drug and medical plans.

Health experts are warning older adults about an uptick in misleading marketing tactics that might lead some to sign up for Medicare Advantage plans that don’t cover their doctors or prescriptions and drive up their out-of-pocket costs.

The disputes involve budget fine print that directed money to AHCA to adjust reimbursement rates so Medicaid providers would pay at least $15 an hour to "direct care" employees

Federal officials said they are penalizing 2,273 hospitals, the fewest since the fiscal year that ended in September 2014. Driving the decline was a change in the formula to compensate for the chaos caused by the COVID-19 pandemic.

The annual open enrollment began Saturday and runs through Dec. 7. The state offers free counseling and information through its SHINE program.

Medicare and Medicaid pay “look-alike” health centers significantly more than hospitals for treating patients, and converting or creating clinics can help hospitals reduce their expenses.

That reduction wouldn’t result from cuts in benefits. Instead, Medicare would be empowered to leverage its market power to pay lower prices for certain drugs.

Elopements, while relatively rare, can be extremely dangerous, especially for people living with dementia. However, every instance raises concern about accountability, awareness, training and lack of "person-centered care."

The Government Accountability Office and Health and Human Services inspector general’s office say seniors enrolled in the program are suffering and taxpayers are getting bilked for billions of dollars a year.