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A Grimm -Outlook
About 10 weeks ago, Christi Grimm was the inspector general and the top watchdog guarded the Ministry of Health and Human Services. And then at night President Trump fired her. Grimm found out the next day, while she drove her young daughter to an earthenware class.
Since then, Grimm and seven other inspectors general who were dismissed Trump and his cabinet officials have claimed that the ends were illegal. She not only regards her shooting as a violation of the law, but as a litmus test of whether the executive power chooses partisely loyalists or independent guardians to eradicate fraud, waste and abuse of Medicare, Medicaid and other health care programs.
Grimm and I spoke for more than two hours last week. She is a self-described “controlled” and explained why she is so concerned about the future of Inspector General and the important work they do. Look to understand that work what Grimm and her desk have done on Medicare Advantage. She outlined her stabbing criticism of Medicare Advantage – and how all administrations did not do enough to control the abuse practices of insurers. Take the time to sit down and read the collection restaurants from our conversation.
A stepback at the 2026 rate
The Medicare Advantage industry received a hugely friendly wage increase for 2026. But here is the thing: this wage increase would have happened, regardless of who was in the White House.
This was a simple application of mathematics to policy: Benchmark payments to Medicare Advantage plans are based on expenditure data in the traditional Medicare program, and added data showed that the expenditure was much higher than when federal officials rolled out the proposal.
But it raises an important question about the structure of the Medicare benefit: do payments still have to be tied to traditional medicine, when that is now the minority of the population and probably a group with more health problems? If that answer remains yes, then we must at least recognize the irony of insurers who criticize the reimbursement for the costs of Medicare, but lobby for higher payments based on … data for the costs for service.
The ‘existential’ unrest within HHS
The Ministry of Health and Human Services is unclosed under the Trump administration. A whole team of Stat reporters has investigated the various agencies and discovered how places such as the NIH should ration and supplies should ration.
The CDC, FDA and NIH have been struck very hard. My colleague Tara Bannow and I discovered that CMS has been saved (it is of course all relative), because having operational medicine and medicaid programs is essential to keep the doors open in American hospitals, doctors and insurance companies.
Medicare and Medicaid payments have not been made and career staff told us that the thousands of pages with important payment instructions will continue to come true as intended. In the corner of CMS that negotiates the prices of medicines with manufacturers on behalf of Medicare, a CMS employee told Tara that it is “things as usual”, and added that “for some reason there is clearly a small halo around us.”
But there have still been cuts on functions that are unknown to the wider public, but serve an important goal. For example, CMS AXED employees of the Medicare-Medicaid coordination office, which supports the low incomes, the elderly who are registered in both programs. Read more to understand what is happening in HHS.
Look ahead to the income
UnitedHealth Group starts on Thursday in the win of the first quarter, now that the second investor call since Brian Thompson was murdered. Expect the managers of UnitedHealth will be delighted with the Medicare Advantage rates for next year.
Also mark your agendas for these other upcoming profit calls:
- April 22: Heimance Health (watch out for Medicaid comments)
- April 22: Intuitive surgical (actually has a higher market capitalization than height)
- April 24: Merck (have we reached Peak Keytruda?)
- April 25: HCA Healthcare (increasingly dependent on special Medicaid funds))
When Eylea helps to upgrade your internet
Sometimes you just need hundreds, even thousands of dollars per month to upgrade your internet.
Regeneron Pharmaceuticals, the maker of drugs such as Eylea eye injection, announced last week that CEO Leonard Schleifer received $ 11,186 for “residential internet equipment and installation/subscription services.” President and Chief Scientific Officer George Yancopoulos received $ 107,059 for “residential internet equipment, licenses and installation/maintenance services.”
“These are largely one-off costs with regard to improved internet services, reliability and security at the residences of the doctors,” said Regeneron spokesperson Alex Bowie. “As active leaders of the company, it is important for Len and George to always be available and to safely download large datasets, gain access to critical documents, etc.”
Industry opportunities and end
- Medicare has released its first 2026 Payment percentages for hospitals On Friday. It would be an increase of 2.4%, but it will change before the final regulations arrive in August. We will dig more in this proposed rule.
- Multiplan – Pardon, Claritev -Is not the only data company that is confronted with accusations of cartel-like behavior on how out-of-network prices for providers are determined. Zelis Healthcare and his large health insurance customers are confronted with a Class Action -Right store That claims that they have shared confidential information to “suppress collusive payments.”
- Medicare now spends more on “skin substitutes” than to ambulance rides, because bandage companies and doctors have set higher prices and have made use of the separate payment policy of Medicare, Sarah Kliff and Katie Thomas from the New York Times report. (It is worth noting that Medicare officials, last week, specifically called “synthetic skin products” to increase Medicare expenditure as part of higher Medicare benefit percentages for next year.)
- During the Change Healthcare Cyberattack of last year, UnitedHealth provided, which has change, loans to medical groups so that they could still have cash and operate while the important payments were clearinghouse down. But now UnitedHealth demands doctors who pay back loans. The American Medical Association asks UnitedHealth for collecting “until the doctor determines that it is the right time, because the doctors have trusted” UnitedHealth’s statements, one AMA -Letter Reads.
- In 2021, Medicare Advantage insurers entered $ 33 billion by adding diagnosis codes to the medical files of patients. UnitedHealth went in 42% of that total in itselfReports Tara.
- ICYMI: Our Colossus team wrote how Republicans – mostly steadfast proponents of Medicare Advantage – increasingly call for reforms of the program. Casey Ross spoke with Rep. Mike Kennedy van Utah, a doctor of general practitioner medicine. Kennedy has first -hand experience with receiving reports from the Housecalls programs from UnitedHealth: “I just came to the point that I did not even open the envelope. I have just shredd all those reports.”
- The legislators of Arkansas want to ban the pharmacy managers have a mail order or retail pharmacies, reports my colleague Ed Silverman.
- The lawsuits led by employees who try to keep employers responsible for blown -up drug spending did not go well, and the lawyers who represent those employees adapt their arguments to tackle the concerns of judges, Lauren Clason Van Bloomberg Law Reports.