American Hospital Association’s Post

The WSJ just uncovered what could be one of the biggest medical frauds in American history. Private insurers in the Medicare Advantage program have allegedly siphoned off up to $591 billion, equivalent to $4,300 per U.S. taxpayer over 18 years. Non-doctor insurance company employees are going into patients' homes, overriding their doctors' diagnoses, and adding new false diagnoses to bill Medicare more. This case, if true, exemplifies how the system is being exploited by greed, eroding trust in the American medical system. Urgent reforms are needed to restore integrity, protect patients and taxpayer dollars, and ensure accountability. Share this to ensure it doesn't get swept under the rug. #MedicareFraud #HealthcareReform

Medicare Part D Open Enrollment can be a confusing time of year for patients. Adding to the confusion, they may be receiving calls or letters from insurance companies saying they have to use a new pharmacy next year. Don't miss out on this opportunity to help your patients! Book Medicare Part D reviews and help them evaluate their options and choose the coverage that is best for them! #independentpharmacy #communitypharmacy #openenrollment #medicarepartd Bob Pessel Adam Salus Tyler Woods PharmD Erica Fett

Do you know what Medicare Part A is? It is considered hospital insurance. Take time this Tuesday to read the article we found for you for more information about Medicare Part A, B, and D. #ADesormier #TuesdayTips #OpenEnrollment #Medicare #HealthInsurance

Despite the US being one of the most advanced superpowers in the world, it’s the only country with a Byzantine payments system for #healthcare. It’s overly complicated by design. Why is that a problem? Besides preventing the average American from understanding #healthcarecosts, pricing, and #employeebenefits (which has resulted in the highest rate of “medical banktrupcy”in the world), its resulting administrative complexity adds tens of billions of dollars of waste to the system annually. What’s that have to do with #insurers and this article? Byzantine medical billing and coding systems are indeed harmful for patients and consumers, but a growing number of insurance companies have cracked the codes allowing them to manipulate said payments systems for financial gain. Many of these schemes target #medicareadvantage and other #taxpayer funded programs, which prompted U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services to start cracking down.

In a bombshell report, The Wall Street Journal details how Medicare Advantage (MA) insurers added diagnoses to patient records, often without the patient or their doctor's knowledge. These diagnoses, sometimes for serious illnesses, inflated insurer payouts from Medicare. The total loss according to the report? As much as $50 billion! We are experienced in navigating the complexities of Medicare Advantage and can help hospitals understand their rights and fight for fair reimbursement. https://lnkd.in/eGE665uE

In a recent quiz by Athene, more than 25% of respondents think at least one medical need is covered by Medicare that isn’t. Medicare beneficiaries either pay out-of-pocket for things like routine dental and vision care or buy separate insurance coverage to help with the bills. Sponsored by Athene.

Here's why you can't "fix" an embedded economic system, why a #ModernStrategy for the largest and most lucrative market on Earth is about 'positioning leverage' rather than positioning a product, why economic innovation should precede technical potential on the roadmap to shareholder value, why digital health in all its forms and permutations and humanity-saving promise is pointed in the wrong direction, and why "transformation" as a battle cry is more vapor from the public relations department than it is fuel to power novel action. Quality journalism via Christopher Weaver, Tom McGinty, Anna Mathews, Mark Maremont, Andrew Mollica @ The Wall Street Journal Brands discussed: UnitedHealth Group, Centers for Medicare & Medicaid Services, KFF, Humana, Mount Sinai Health System, Elevance Health, The Cigna Group, Freedom Health Insurance, AHIP, HouseCalls Home Care For more insight, see 'The American Way of Healthcare Needs a New System of Markets' published on #FreshPaint, the Blue Spoon platform dedicated to breaking the hold and the mold of #GroupThink sustaining the Standard Model https://lnkd.in/eJRcsrvg