Author: Kevin Thilborger
DOJ: Pushing back on alleged kickbacks
The US Department of Justice alleges that three MA plans and their appointed brokers committed offenses against the False Claims Act.
CMS gives increases to Medicare Advantage plans and decreases to physicians
MA plans are bad for taxpayers, beneficiaries, and providers. So why has CMS authorized increased payment rates to MA payors for 2026?
What to expect in 2025: Managed care trends and predictions
New president. New Congress. Decades old healthcare cost finger pointing. Payors and providers say change is needed. Yet there’s no consensus on how to achieve it. In our new report, we share...
More Medicare Advantage turmoil
Medicare Advantage plans face growing scrutiny and rejection by providers due to payment challenges and administrative complexities, prompting hospitals to reassess contracts and seek strategic support for managed care negotiations...
New era of conflict with independent Blues?
Independent Blue Cross Blue Shield plans are increasingly in conflict with providers due to aggressive cost-cutting measures, high denial rates, and contentious contract negotiations, emphasizing the need for strategic managed...
May you live in interesting times
The current healthcare system, dominated by a few powerful health plans, highlights the urgent need for systemic redesign focused on patients rather than insurance companies, requiring long-term strategies and transformative...
Hospitals are damned if they do, damned if they don’t
Hospitals, facing mounting bad debt from insured patients and pressures from the No Surprises Act, are increasingly requiring advance payments for non-emergency care, navigating criticism while striving to balance financial...
Prior authorizations should be renamed ‘the Care Avoidance Process’
The widespread use of prior authorizations by insurers delays care, undermines physician-patient relationships, and improperly denies treatment, highlighting the urgent need for collective provider action and stronger protections against these...
Is the nation’s largest payor becoming a closed system?
UnitedHealth Group's transformation into a closed healthcare system, driven by its subsidiary Optum, raises concerns about reduced competition, patient choice, and fairness, emphasizing the need for providers to secure protective...