Whistleblower’s Claims About Medicare Advantage
A former official at UnitedHealth is asserting that big insurance companies are gaming Medicare Advantage, and have been doing so for years. The New York Times reported that a whistleblower described how companies gamed the system to make patients look sicker than they were in order to get more money from Medicare Advantage. The Department of Justice is taking the claims seriously and has said it intends to sue UnitedHealth Group and investigate other participants in Medicare Advantage.
Small Businesses Can Bypass HealthCare.gov
A new Trump administration rule change will allow small businesses to sign up for insurance through an agent or broker instead of HealthCare.gov. Currently, there are 85,000 people covered through the Small Business Health Options Program, which is far less than the millions expected when the program launched, reported The Hill. The rule change will take effect January 1, 2018, and businesses will still have to use HealthCare.gov to determine eligibility.
California Considers Protecting Family Planning Services
A new bill in California would allow patients to get care from the provider they are most comfortable with. According to California Healthline, the bill is being used to keep the federal rule that allows Medicaid patients to see the family planning provider they want, thus protecting access to Planned Parenthood and similar health clinics. The bill, which cleared the Senate Health Committee and now goes to the Senate Appropriations Committee, protects access even as the American Health Care Act that passed the US House of Representatives cuts federal funding for Planned Parenthood.
AI in Health Care: Balancing Governance, Innovation, and Trust
September 2nd 2025In this conversation with Reuben Daniel, associate vice president of artificial intelligence at UPMC Health Plan, we dive into how UPMC Health Plan builds trust with providers and members, discuss challenges of scaling AI effectively, and hear about concrete examples of AI's positive impact.
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Infertility Coverage Boosts ART Use and Pregnancy Success: Richard A. Brook, MS, MBA
August 26th 2025In this episode, Richard A. Brook, MS, MBA, discusses his study showing that infertility treatment coverage increases assisted reproductive technology (ART) use and improves pregnancy outcomes.
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