Tag Archives: Medicare

‘This Should Be a National Scandal’: For-Profit Medicare Advantage Plans Using AI for Denials

“They’re using AI to predict when to cut off payment for treatments,” said one watchdog group. “We repeat, AI. Not a doctor.”

By Brett Wilkins. Published 11-3-2023 by Common Dreams

*Single payer protest in Baltimore, MD Photo: Elvert Barnes/flickr/CC*

As Medicare Advantage plans rely increasingly upon artificial intelligence to determine—and often deny—payment for patient care, a group of Democratic U.S. lawmakers on Friday urged Medicare’s top official to strengthen oversight of AI and algorithmic tools used to make coverage determinations.

“In recent years, problems posed by prior authorization have been exacerbated by MA plans’ increasing use of AI or algorithmic software to assist in their coverage determinations in certain care settings, including inpatient hospitals, skilled nursing facilities, and home health,” 32 House Democrats led by Rep. Judy Chu (D-Calif.) wrote in a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Books LaSure.

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Medicare Advantage Overbills Taxpayers by $140 Billion a Year—Enough to Wipe Out Medicare Premiums

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“Medicare Advantage is just another example of the endless greed of the insurance industry poisoning American healthcare,” says a new report from Physicians for a National Health Program.

By Jake Johnson. Published 10-4-2023 by Common Dreams

A report published Wednesday estimates that privately run, government-funded Medicare Advantage plans are overcharging U.S. taxpayers by up to $140 billion per year, a sum that could be used to completely eliminate Medicare Part B premiums or fully fund Medicare’s prescription drug program.

Physicians for a National Health Program (PNHP), an advocacy group that supports transitioning to a single-payer health insurance system, found that Medicare Advantage (MA) overbills the federal government by at least $88 billion per year, based on 2022 spending.

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In ‘First Major Blow to Big Pharma,’ Federal Judge Blocks Medicare Drug Price Negotiation Injunction

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The judge said plaintiff the Chamber of Commerce “demonstrated neither a strong likelihood of success nor irreparable harm.”

By Olivia Rosane. Published 9-30-2023 by Common Dreams

A federal judge in Ohio on Friday blocked an attempt by corporate interests to stop Medicare’s historic negotiation of certain drug prices with pharmaceuticals.

Medicare gained the power to negotiate drug prices as part of the Inflation Reduction Act (IRA), but the several industry groups and drug makers have sued to forestall the program, arguing that it is unconstitutional, CNN explained. One of those groups was the U.S. Chamber of Commerce, which filed its lawsuit in June. The Ohio judge Friday rejected its request for a preliminary injunction to block the program before October 1, the date by which pharmaceuticals must agree to negotiate or not.

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Trustees Report Shows Social Security Expansion a ‘Question of Values, Not Affordability’

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“The trust funds are strong because most Americans contribute to them with every paycheck,” said one advocate. “They could be even stronger if the wealthiest Americans paid their fair share.”

By Jake Johnson. Published 3-31-2023 by Common Dreams

Rally at Minneapolis Social Security Office i August of 2012/ Photo: AFGE/flickr/CC

The board of trustees for Medicare and Social Security released a report Friday showing the programs’ trust funds will be able to cover all benefits and expenses until 2031 and 2034 respectively, findings welcomed by advocates as further confirmation that the key lifelines are strong and can be expanded.

Nancy Altman, president of the progressive advocacy group Social Security Works, argued in a statement that “the takeaway from this report is that whether to expand or cut Social Security’s modest but vital benefits is a question of values, not affordability.” Continue reading →

Pharma Giants to Hike 350+ US Drug Prices in the New Year: Analysis

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“Why? Because they can. Big Pharma does not care about us.”

By Brett Wilkins. Published 12-30-2022 by Common Dreams

Photo: Images Money/flickr/CC

Global pharmaceutical giants plan to hike U.S. prices for hundreds of drugs next month in anticipation of the Biden administration’s Inflation Reduction Act, which will allow Medicare to negotiate the cost of certain drugs starting in 2026, an analysis published Friday revealed.

The analysis, conducted by the healthcare research company 3 Axis Advisors and reported on by Reuters, said that Big Pharma corporations including Pfizer, AstraZeneca PLC, and Sanofi SA are set to raise the list prices—which do not include any rebates—on over 350 drugs early in January. Continue reading →

As Scandals Mount, So Do Calls to Abolish Private Medicare Advantage Plans

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“Problems with Medicare Advantage are systemic and widespread,” said Rep. Pramila Jayapal. “Not only do they too often deny care—they’re ripping off taxpayers.”

By Brett Wilkins. Published 12-13-2022 by Common Dreams

Photo: K Whiteford/Public domain

As yet another scandal involving Medicare Advantage made headlines this week, progressive U.S. lawmakers and advocates renewed calls to abolish the private health insurance program that a recent Senate report said is “running amok” with “fraudsters and scam artists.”

In a new Nation article written with health insurance reform advocate Wendell Potter, Reps. Ro Khanna (D-Calif.) and Mark Pocan (D-Wis.) contend that one of the most confusing things facing elders while choosing their Medicare plans “is a scheme by private insurance companies to prey on seniors and profit off of the Medicare brand, all in the name of padding their corporate profits and shareholder returns.” Continue reading →

Lame-Duck Dems Must Lift Debt Limit, Advocates Say as GOP Doubles Down on Social Security Threats

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“Democrats must do whatever it takes to defeat Republican attacks on our earned Social Security benefits,” said one advocate. “That means raising the debt ceiling this year, before Republicans take control of the House.”

By Julia Conley. Published 11-30-2022 by Common Dreams

#StoptheShutdown Press Conference with Speaker Pelosi and Senator Schumer in 2019. Photo: AFGE/flickr/CC

Progressives on Wednesday warned that time is running out for Democratic leaders to take Republicans at their word regarding slashes to social safety net programs, as U.S. Sen. John Thune indicated the GOP will use a potential fight over the debt ceiling next year as leverage to push cuts—unless the Democrats act now to raise the debt limit while they still control the Senate and House.

Thune (R-S.D.), who is the number-two Republican in the Senate as the chamber’s minority whip, told Bloomberg Tuesday that the party has a “long list” of policy priorities for the next Congress, which will commence on January 3. The party plans to put forward budget reforms including to federal programs which they have long claimed, erroneously, are unsustainable. Continue reading →

Austin AFL-CIO Council Becomes Latest to Urge Biden to End Medicare Privatization Scheme

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The labor council’s newly passed resolution warns that the scheme “allows doctors and their offices to convert a patients’ traditional Medicare choice into ACO-REACH coverage without first informing their patients.”

By Jake Johnson Published 11-21-2022 by Common Dreams

Health and Human Services Secretary Xavier Becerra. Photo: Gage Skidmore/flickr/CC

The labor council of the Austin, Texas AFL-CIO has passed a resolution urging the Biden administration to terminate a Medicare privatization scheme that is quietly moving ahead despite vocal opposition from doctors, seniors, and progressive lawmakers.

The pilot program, which inserts private middlemen between patients and healthcare providers, was unveiled with little notice during the final months of the Trump administration despite internal concerns about its legality. The experiment has since been largely upheld by the Biden administration, which announced mostly cosmetic changes earlier this year, winning applause from industry groups that lobbied against complete elimination of the program. Continue reading →

Patients Push Biden HHS to Act as Pharma Firm Charges $190K for Lifesaving Prostate Cancer Drug

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“HHS can clearly insist on limiting the U.S. price of Xtandi to the median price for other large high-income countries,” said advocates, “particularly since the drug has already generated more than $10 billion in sales from Medicare alone based upon these unconscionable pricing disparities.”

By Brett Wilkins Published 11-20-2022 by Common Dreams

Screenshot: GlobalGiving

“Cancer does not wait, nor should cancer patients have to wait for years for their government to act.”

That’s the message patient advocates reiterated in a Friday letter asking the Biden administration to help them secure a lifesaving prostate cancer drug that costs nearly $190,000 per year despite its development being 100% taxpayer-funded.

Last year, prostate cancer patient Eric Sawyer petitioned U.S. Health and Human Services (HHS) Secretary Xavier Becerra to grant march-in rights—under which the government can grant patent licenses to companies other than a drug’s manufacturer—for enzalutamide, which is sold under the brand name Xtandi. Continue reading →

GOP Threatens to Hold Economy Hostage to Slash Climate Investments

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“If Republicans take over Congress, they plan to hold the government hostage and ransom our future,” said one climate advocate.

By Jake Johnson Published 10-25-2022 by Common Dreams

Screenshot: CNN

In addition to threatening cuts to Social Security and Medicare, congressional Republicans are reportedly plotting to use the debt ceiling and an end-of-year clash over government funding to target popular climate investments approved in August as part of the Inflation Reduction Act.

The Washington Post reported Tuesday that “while some Republicans do favor brinkmanship over Medicare and Social Security… some aides and analysts think the GOP may be more likely to demand changes to other Democratic priorities.” Continue reading →

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Tag Archives: Medicare