Health Insurance and Managed Care

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    Have you seen examples of health care fraud, waste or abuse? Tell us about it.

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    New York Times reporters are looking into cases of unnecessary and wasteful spending in government health programs.In 2023, companies billed Medicare for hundreds of thousands of urinary catheters that doctors never ordered. The next year, doctors collected billions from the government for pricey bandages that were sometimes unneeded.Medicare waste has wide-reaching consequences. Even if patients do not pay the bills themselves, more spending by the government insurance program can increase future premiums.The New York Times wants to better understand what fraud, waste and abuse looks like in today’s health care system. Are there other instances of wasteful spending we should be investigating? Tell us about them. We are especially interested in cases that involve federal health care programs, like Medicare, Medicaid and Veterans Affairs.We will follow up with you before publishing any part of your response or your name.Help us investigate health care waste, fraud and abuse More

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      How Much Should Weight Loss Drugs Like Wegovy and Zepbound Cost?

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      A new study found that fair prices for medications like Wegovy and Zepbound would be hundreds less per month than they are now.It’s easy to make a medical case for blockbuster weight loss drugs like Wegovy and Zepbound, which have been shown to prevent heart attacks and strokes and save lives.But for the employers and government programs being asked to pay for the medications, the financial case for them is less clear. Are the drugs’ benefits worth their enormous cost?The answer right now is no, according to a new study published on Friday in the journal JAMA Health Forum, by researchers at the University of Chicago.To be considered cost effective by a common measure used by health economists, the price of Novo Nordisk’s Wegovy would need to be cut by over 80 percent, to $127 per month, the researchers concluded. And Eli Lilly’s Zepbound would be cost effective only if its price fell by nearly a third, to $361 per month. (Zepbound warranted a higher price, the researchers said, because it produced greater benefits in clinical trials.)“There’s no doubt that the drugs are demonstrating tremendous health benefits,” said David Kim, a health economist at the University of Chicago and the senior author of the study, which was funded by government grants. “The problem is the price is too high.”There’s widespread hope that the drugs will effectively pay for themselves in the long run, by making patients healthier and preventing expensive medical bills. It’s not clear yet whether that will turn out to be true.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      How Covid Changed the Lives of These 29 Americans

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      Five years ago, Covid took hold and the world transformed almost overnight. As routines and rituals evaporated, often replaced by grief, fear and isolation, many of us wondered: When will things go back to normal? Could they ever? Today, for many, the coronavirus pandemic seems far away and foggy, while for others it’s as visceral […] More

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      What Can House Republicans Cut Instead of Medicaid? Not Much.

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      The math of the G.O.P.’s goals makes the move almost unavoidable.The House passed a budget resolution Tuesday night after the speaker, Mike Johnson, persuaded several Republican lawmakers, including those who have expressed reservations about possible Medicaid cuts, to support the bill.In theory, the budget, which kicks off the process of passing an extension of tax cuts enacted in 2017 and up to $2 trillion in spending cuts meant to partly offset them, could become law without significant cuts to Medicaid. But it won’t be easy. More

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      Trump Returns to a Favorite Issue: Health Care Price Transparency

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      In a new executive order, President Trump will reaffirm his commitment to one of his favorite health care policies of his first term: His push to make the prices paid for medical services more public and transparent.Mr. Trump will sign the order on Tuesday afternoon, according to a White House official. After years of halfhearted compliance from hospitals and insurance companies with the previous policies, Mr. Trump is signaling a more aggressive approach to enforcing the rules and making pricing data accessible to patients, the official said.Health care prices have historically been shrouded in secrecy, negotiated in private between doctors, hospitals, drug companies and the insurance companies that pay their bills. The parties in those negotiations have fought hard to keep those numbers out of public view, saying that confidentiality is key to their bargaining process. Economics literature — which relied heavily on a study of Danish concrete prices in the 1990s — has suggested that making them public could actually backfire, by increasing health care prices.But with two major rules issued jointly by the departments of Health and Human Services, Treasury and Labor during his first term, Mr. Trump tried to force the industry to become more transparent. One rule required hospitals to publish the prices they charged to various insurers for a set of common services. Another required insurance companies to publish a more comprehensive listing of the prices they had negotiated with various health care providers.Industry compliance has been grudging, slow and marked by extensive litigation. After the rules became final in 2021, many hospitals simply declined to publish the required lists. Others tried to make their price information hard to find. The Wall Street Journal reported that several had inserted code into their web pages listing prices that made the pages impossible to find using an internet search engine.Nevertheless, the requirement did provide new information to researchers, employers and some patients about the nature of health care prices — and their wide and often inexplicable variation. The policy has so far not delivered on one of Mr. Trump’s key promises from his last term, that price transparency would significantly drive down health care costs. Health care prices have continued to rise.The new executive order will task H.H.S., Treasury and Labor with considering new ways to expand the reach of current initiatives, but it does not call for much in the way of specific new policy. Any meaningful new transparency initiative would require regulatory action or legislation, or both. But the signing of the new order does suggest that Mr. Trump has not forgotten about this priority, which he often referred to in his first term as “bigger than health care itself.” More

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      How to Use an HSA to Save a Lot

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      A new analysis finds that a diligent saver who leaves the money untouched for decades can accumulate $1 million. But not everyone with an H.S.A. can afford to leave the money untapped.It’s possible to amass $1 million in special health savings accounts to use in retirement, a new analysis finds, with several big caveats.You have to start young, contribute the maximum each year and leave the money untouched for decades instead of spending it on medical needs.Health savings accounts, known as H.S.A.s, let people set aside pretax money for health and medical care.To open an H.S.A., you must have a specific type of health plan with a high deductible — an amount you must cover out of pocket before insurance pays. The money can be saved or invested to grow tax-free, and is tax-free when withdrawn and spent on eligible care or products. (The federal government does not tax the accounts, but some states assess state taxes.)Because of their robust tax advantages, H.S.A.s are seen as a valuable tool to save for health needs later in life, including costs that aren’t covered by Medicare, the federal health plan for older Americans. H.S.A. funds can also be spent on nonmedical costs after age 65 without penalty. The money is taxed as ordinary income.The new analysis by the Employee Benefit Research Institute, a nonprofit group, assumes that at age 25, a saver begins contributing the maximum allowable amount each year ($4,300 for an individual in 2025 — the amount is tweaked annually for inflation — and an additional $1,000 for people 55 and older) and continues those contributions through age 64 with no withdrawals, “regardless of whether the individual uses any health care services.” It also assumes the funds are invested and earn a 7.5 percent rate of return.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Anger After UnitedHealthcare CEO’s Killing Rattles Health Insurance Workers

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      Employees at UnitedHealthcare and other companies described being anxious after an outpouring of online vitriol.The fatal shooting last week of an executive on the streets of New York City plunged his family members and colleagues into grief. For rank-and-file employees across the health insurance industry, the killing has left them with an additional emotion: fear, with many frightened for their own safety and feeling under attack for their work.Health insurance companies have increased security measures since the killing of Brian Thompson, the chief executive of UnitedHealthcare, and as an outpouring of online rage toward the industry has followed. Health care leaders have spoken with frustration about feeling vilified, and in the Minneapolis suburbs where United is headquartered, police officers stepped up protection of the company’s offices.“Clearly the employees have been shaken,” said Mayor Brad Wiersum of Minnetonka, who said the city was working “just to provide that reassurance and that security, to let people know that we are going to do everything we can to keep them safe.”One UnitedHealthcare worker who processes claims described being cleareyed about the American health care system’s shortcomings, but also believes that she and her colleagues did their best to help patients within the limits of that system. Like most workers interviewed, she did not want to be named because, given the reaction after Mr. Thompson’s killing, she feared for her own safety.The reaction by some others to the killing, the employee said, had been startling and horrifying. The worker, who has been at the company for many years, described being told in recent days by an acquaintance that as an employee of UnitedHealthcare she was responsible for millions of people being denied lifesaving care, and that if she had any ethics, she would see the killing as the impetus to quit her job.“Lots of us were feeling like we were horrible because we’re being accused of working for the evil empire,” the employee said. “But we all do the best we can to do a good job in the system we are in.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      UnitedHealthcare CEO Brian Thompson’s Funeral Held Privately in Minnesota 

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      Brian Thompson, the chief executive of UnitedHealthcare who was gunned down in a brazen killing in New York, was laid to rest this week at a private funeral service in his Minnesota hometown.On Monday, while the nation was transfixed by the arrest of a 26-year-old man from Maryland who was charged with the murder, family and friends of the slain executive gathered at a Lutheran church in Maple Grove, Minn., to mourn the loss of a husband and father who ascended from modest roots in Iowa to one of the most powerful roles in the health care industry.In the days since Mr. Thompson’s death, there has been an outpouring of anger at the insurance industry for denying medical claims, with some people even seeming to cheer his killing online. The vitriol has stunned those who were closest to Mr. Thompson, leaving many of them to grieve his death in private ways.“Brian was an incredibly loving husband, son, brother and friend,” Mr. Thompson’s family said in a statement. “Most importantly, Brian was a devoted father to our two sons, and we will miss him for the rest of our lives. We appreciate the overwhelming outpouring of kind words and support we have received.”Mr. Thompson, 50, grew up in a working-class family in Jewell, Iowa. His mother was a beautician, according to family friends, and his father worked at a facility to store grain, according to an obituary of his father.He spent his childhood summers “walking beans” on farms, going row by row through the fields to kill weeds with a knife, or working manual labor at turkey and hog farms, according to two friends.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Reaction to C.E.O. Killing Exposes Frustrations With Health System

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      The killing of the UnitedHealthcare chief executive Brian Thompson has mesmerized a deeply polarized nation that shares a collective frustration over dealings with health insurance companies.On social media, some people have cheered for the gunman and expressed little remorse over the death of Mr. Thompson, 50, a father of two boys from Maple Grove, Minn., with some painting him as the villain in a national health care crisis.And now that the identity of the suspect, Luigi Mangione, 26, has been revealed and more photos of him have emerged, he is being defended or even applauded in some circles. That adulation reflects public anger over health care, said Nsikan Akpan, managing editor for Think Global Health, a publication that explores health issues at the Council on Foreign Relations. “The UHC killing and the social media response stem from people feeling helpless over health coverage and income inequality,” he said. The topic is so often ignored by American public officials, he said, that voters have stopped listing it as a top priority.“A targeted killing won’t solve those problems, and neither will condoning it,” he added.Experts who reviewed the flood of social media posts expressing support for Mr. Mangione said that while it can be difficult to assess the provenance of posts, none have the telltale signs of an “influence campaign” by a foreign entity.“People are legitimately actually pissed off at the health care industry, and there is some kind of support for vigilante justice,” said Tim Weninger, a computer science professor at Notre Dame and expert in social media and artificial intelligence. “It’s organic.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More