Independence Blue Cross, the largest medical insurance provider in the Philadelphia area, does not admit to wrongdoing. It was accused in a lawsuit backed by the U.S. Department of Justice of misrepresenting the severity of patient illnesses to juice risk-adjusted Medicare payments.
The reason for the payouts is a bit fuzzy, but the White House said it has to do with user fees that the Centers for Medicare & Medicaid Services charged to the states, which should have been passed on to enrollees as they sign up for insurance on HealthCare.gov
Analyzing more than 1,500 cases of patients who got sent from an acute-care hospital to an ostensibly more-capable facility, Harvard researchers have found 1 in 4 such transfers could—and probably should—have been avoided.
A study from the University of Iowa Health Care found that age and gender played a role in self-reported long COVID symptoms, but the recency of a COVID-19 vaccine or booster was not a factor.
With its $350M in new funding, EliseAI said it plans to build out its technology and sales force. It currently works with specialty provider groups to automate practice operations such as scheduling and insurance verification.
For 2027, CMS said it anticipates that 34 million seniors will be enrolled in a Medicare Part C plan, representing 47% of all Medicare-eligible seniors.
