audits

Somehow the overall failings of the healthcare system are the fault of health plan executives I wade into this debate with some anxiety, but I am frankly astonished by the online vitriol since the blatant assassination of UnitedHealthcare CEO Brian Thompson. Law enforcement believes the killing was clearly targeted, especially given the inscriptions on shell casings which said “delay, deny and defend.” Terribly, some have celebrated Thompson’s death or argued that he deserved to die given his business’ practices. Others have used the tragedy to attack health plans as evil entities that seek simply to deny or delay care. The social media comments single health insurers out as the sole bogeyman in the national healthcare debate. Far-left groups’ posts speculate about soon-to-be-unearthed sinister plots and treachery that are at the heart of the assassination. To me, all the comments are unfortunate and lack important perspective. Bruce Japsen, a writer for

New measures and major Star changes coming The just released 2026 Medicare Advantage and Part D rule from the Centers for Medicare and Medicaid Services (CMS) has a number of important Star program measure and policy updates. As promised, here is my thorough assessment of the Star changes from the rule. See Monday’s blog here for the rest of the proposals in the rule: https://www.healthcarelabyrinth.com/large-ma-and-part-d-rule-issued-for-2026/ . Will the changes really go into effect? What will happen to these proposals is anyone’s guess right now. The Biden administration did not publish the rule in time to finalize it before the current president leaves office. That will allow the incoming Trump administration the ability to delay final publication and remove significant portions if it wants to. I don’t expect the new administration to disturb some of the technical changes and customary roll out of Star measures, but it likley will stop some

2026 Medicare Advantage and Part D rule has major changes to the programs The Biden administration issued its draft 2026 Medicare Advantage (MA) and Part D rule last week. A draft is available, but the Federal Register indicates the rule was pulled back for additional clarifications and would be reposted on December 10. Due to its late posting, the rule will not be finalized before the Trump administration takes office and therefore could simply be revamped rather than be rescinded. In some ways, the rule does not have some of the mega changes that some expected in the areas of Star, risk adjustment, and more. This could be due to some sensitivity to the current financial woes of the MA industry. But there is plenty for the industry to object to. I have read the 700-plus page draft rule and reviewed the Centers for Medicare and Medicaid Services (CMS) Fact

The Gaetz withdrawal shows the Constitution is being taken seriously Another quick deviation from healthcare in the interest of democracy this Thanksgiving weekend. On November 18, my blog covered the issue of recess appointments. I said that the Senate has to fulfill its constitutional functions and resist the concept of recess appointments as recommended by President-elect Donald Trump. Days after taking office, President-elect Trump urged the Senate to allow him to make such recess appointments to get his cabinet and other key officials in place quickly. I argued that this would amount to an abrogation of the Senate’s duty to vet and approve key officials. Yes, recess appointments are mentioned in the Constitution, but the provision was included for good reason in bygone days when Congress was not in session year-round. It helped ensure government could function properly by giving the president some latitude to appoint officials when Congress was

Medicare Advantage (MA) could benefit under Trump, Kennedy, Oz With the nominations of Robert F. Kennedy Jr. as Health and Human Services Secretary and Mehmet Oz as Administrator of the Centers for Medicare and Medicaid Services (CMS), a slightly clearer picture has emerged as to what we can expect for healthcare policy and coverage. Admittedly, there is a lot still in question. Kennedy likely focuses on his core concerns If he does get confirmed, Kennedy is likely to focus on his passions of reforming the health regulatory agencies and bringing greater transparency to drug and food regulation.  In addition, he wants to impact chronic disease in a big way. Kennedy is a known vaccine skeptic. Under him will serve Dr. Marty Makary as Commissioner of the Food and Drug Administration (FDA) and Dr. Dave Weldon, Director of the Centers for Disease Control and Prevention (CDC). Both Makary and Weldon are

Medicare Advantage (MA) growth continues as we enter 2025 enrollment season I decided to continue my Medicare Advantage (MA) monthly enrollment blogs because of continuing month-over-month increases. The growth is tied to remaining strong benefit packages for 2024. Increases in MA enrollment still occur outside of the enrollment season given the aging of America and the ability of some populations, such as dual eligibles, to continue to make changes throughout the year. We are now in the enrollment season for 2025 and I wonder if we will see the normally robust month-over-month growth. So far, it seems to be there. New enrollees see huge value in enrolling in MA over the traditional fee-for-service (FFS) program. This value difference likely will continue to drive some growth in 2025 even with reductions in benefits, increased premiums and cost-sharing, and less choice in some geographies. The reductions are being caused by the return of

The Senate should resist being pressured and fulfill its constitutional duties. The Republic will survive a speedy but thorough vetting process for nominees. While this blog’s topic would impact healthcare, I admit I am straying a bit from my normal musings here on the website. I usually try to keep politics largely out of my blogging. I describe myself as a moderate Republican, who holds healthcare views that span both of today’s parties. I tend to favor reasonably expansive healthcare coverage with government support, lining me up with Democrats. I think it is a wise and compassionate position. Affordable universal access will save healthcare dollars and is key to healthcare reform, which also includes price reform and a pivot to care management. At the same time, I remain a fiscal conservative who thinks that our national debt and deficits will lead to a lower standard of living and less opportunity