Medicare Advantage

United Healthcare Services Inc., which runs the nation’s largest private Medicare Advantage insurance plan, concealed hundreds of complaints of enrollment fraud and other misconduct from federal officials as part of a scheme to collect bonus payments it didn’t deserve, a newly unsealed whistleblower lawsuit alleges.

Court Rejects Appeal In Medicare Advantage Dispute

Jul 20, 2017

An appeals court Wednesday rejected arguments that an arbitrator could have been biased in a dispute involving an insurance firm's attempt to receive $24 million in damages from UnitedHealthcare.

FL-Based Medicare Plans Pay $32M To Settle Charges

May 31, 2017

Two Tampa-based Medicare Advantage health plans have agreed to pay nearly $32 million to settle a whistleblower lawsuit that alleged they exaggerated how sick patients were and took other steps to overbill the government health plan for the elderly.

Humana, Florida’s largest Medicare managed-care company, says it will lay off hundreds of employees in April, including 328 in Florida.

Of those, 260 are in the Tampa Bay area, according to Humana spokeswoman Nancy Hanewinckel.

WellCare Health Plans has made an offer for the Medicare Advantage insurance plans that Aetna plans to shed, according to Reuters.

Florida Regulators OK Anthem-Cigna Insurance Deal

Apr 4, 2016

State insurance regulators have approved Anthem's purchase of Cigna's Florida companies as part of a broader merger of the major health insurers.

Senior citizens are switching from privately run insurance plans to traditional Medicare when they face serious, long-term health conditions, a study shows.

Researchers at Brown University found that 17 percent of Medicare Advantage patients who entered nursing homes for long-term care chose to switch to traditional Medicare the following year. Only 3 percent of similar patients in Medicare made the decision to go to a private Medicare Advantage plan.

Here's a bit of good news for Medicare, the popular government program that's turning 50 this week. Older Americans on Medicare are spending less time in the hospital; they're living longer; and the cost of a typical hospital stay has actually come down over the past 15 years, according to a study in the Journal of the American Medical Association.

(Editor's Note: It's Medicare enrollment season, now through Dec. 7, and beneficiaries are trying to decide on a plan. Health News Florida’s Carol Gentry, who has covered Medicare for many years, is seeing the federal program from a new point of view: as a beneficiary. Her first commentary, which aired Oct. 9, was "Medicare's Complexity Can Be Scary." The second one, "Which Medicare Path Do I Take?" is below).

Just a handful of Florida Medicare Advantage plans offered for 2015 received below average scores in a federal quality rating system, a breakdown of data by Avalere Health shows.

Many Florida shoppers at Medicare.gov will find Day Break and Sunrise among their lowest-priced HMO options. But if they call to enroll in either one, they’re out of luck.

Florida Healthcare Plus, a small Coral Gables company that sponsors the two Medicare Advantage plans, is under state and federal suspension, unable to sign up new members during the current open-enrollment season for Medicare, Oct. 15-Dec. 7. Being frozen at this time of year can be a death sentence for such plans.

Sunday is the final day seniors covered by a now-defunct Medicare Advantage plan can select a different policy.

The state’s Department of Financial Services took over operation of the Physician’s United Plan in early June, when it was more than $13 million in debt and unable to pay many creditors.

  

Unpaid claims. Coverage Denied. Liquidation.

These are not words you want associated with your health insurance company.

Feds Probe Humana Medicare in FL

May 20, 2014

  Giant health insurer Humana Inc. faces multiple federal investigations into allegations that it over-billed the government for treating elderly patients enrolled in its Medicare Advantage plans, court records reveal.

The status of the investigations is not clear, but they apparently involve several branches of the Justice Department. The U.S. Attorney’s Office in Miami wrote in a court document filed in March that officials expect that at least one of the probes will be completed and the findings made public “in the next few months.”

While only a small fraction of doctors receive more than $3 million a year from Medicare, Florida accounts for way more than its share -- one in four. And guess which state is home to the doctor who made nearly $21 million?

Those are among the findings of an Associated Press analysis of physician data released Wednesday by the Obama administration, part of a move to open the books on health care financing.

FL Medicare Plan Ratings Up

Nov 8, 2013

More than half of the Medicare Advantage plans available for enrollment now in Florida for 2014 coverage earned a rating of at least four stars out of five, according to data organized by Avalere Health

Four Florida plans -- all sponsored by Cigna -- earned the coveted five-star rating: three plans in Bay County and one in Miami-Dade. There were no five-star Advantage plans available in 2013 anywhere in Florida.

Cutting Through Medicare Ad Onslaught

Nov 7, 2013

It's open enrollment season for Medicare, the time when beneficiaries can switch plans if they want. Plenty of private insurance companies are competing to enroll them in Medicare Advantage plans.

If you have Medicare, or you're getting close to age 65, your mailbox is likely overflowing with offers. The ads are coming at you on TV, too. 

WellCare Ousts CEO Even Though Earnings Up

Nov 1, 2013

Tampa-based WellCare Health Plans, Inc. has replaced chief executive officer Alec Cunningham with chairman David Gallitano. 

The trial began today for the white Florida man accused of shooting and killing an unarmed black teen in November 2012, raising comparisons to the Trayvon Martin case.

Michael Dunn pulled into a Jacksonville gas station and parked next to the SUV in which 17-year-old Jordan Davis was sitting in with three friends. The 47-year-old software developer from Satellite Beach was waiting for his fiancée to return from the convenience store when he told the teens to turn their music down.

Today, Oct. 15, is the first day of open enrollment for Medicare beneficiaries to choose their drug plan and HMO-style Medicare Advantage plan for 2014.  They can save money if they do some research, but if they don't, most will pay more this year. 

Researchers on Medicare enrollment predict that millions of beneficiaries will remain in their current plan rather than hassle with doing the research to see what has changed. And that would be a mistake, since so many plans are switching the drugs they cover or the premiums and co-pays they charge.

Pages