Latest news with #UnitedHealthcare
Yahoo
a day ago
- Entertainment
- Yahoo
John Wilkes Booth takes center stage in ‘Mad Men' creator's new play
(NewsNation) — 'Mad Men' creator Matthew Weiner's directorial play debut puts one of America's most notorious killers in the spotlight. 'John Wilkes Booth: One Night Only,' brought to life with the help of producer Ken-Matt Martin, centers on the man who shot and killed President Abraham Lincoln. Former Red Hot Chili Peppers guitarist takes plea deal in fatal crash: report 'We learn a lot from studying our villains,' Weiner told NewsNation. 'And the thing that really got to me is how much we live in the shadow of his act.' Examining infamous figures 'tells us more about who we are as a country than it does just looking at our heroes,' Martin said. Booth, a Baltimore native, was 26 at the time of Lincoln's assassination. When asked about the parallels between Booth and Luigi Mangione — who is accused of killing of UnitedHealthcare CEO Brian Thompson — Martin and Weiner emphasized the importance of interrogating violence's place in American history. Mangione is also from Maryland and was 26 years old when Thompson was killed. 'The thing that I think is at the core of why it's important for us to be producing and looking at, it's not to glorify, but it's actually to better understand and contextualize why people do the things that they do,' Martin said. Chrisleys set to make TV comeback after Trump pardons Weiner echoed that sentiment. 'America is proud of its anti-authority nature,' he said.' But the reality is most of the changes that have happened in this country eventually come into the hands of violence. It is part of, unfortunately, the way this country was born, and it's part of our mythology.' 'This is a challenging thought to open your mind to,' Weiner continued. 'The idea that there is something particular to America that produces people like this, and that we live in their destruction, and that we need to understand them so that we can move beyond this.' The play will run from May 15 to June 15 at Baltimore Center Stage. It is recommended for audiences 14 and older. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
2 days ago
- Business
- Yahoo
UnitedHealth (UNH) Sets Sights on Market Comeback After Brutal Quarter
UnitedHealth Group's stock (UNH) has hit a rough patch, weighed down by regulatory pressure on its Medicare Advantage programs and rising medical costs. But stepping back from the current turbulence, there's reason for cautious optimism. UnitedHealth's strategic direction and diversified business model leave it well-positioned to benefit from long-term healthcare trends, even as it navigates short-term headwinds. All things considered, I remain cautiously bullish on UNH. Easily unpack a company's performance with TipRanks' new KPI Data for smart investment decisions Receive undervalued, market resilient stocks right to your inbox with TipRanks' Smart Value Newsletter UnitedHealth is facing challenges on multiple fronts. Most notably, the Department of Justice (DOJ) is investigating potential fraud in its largest revenue source, the Medicare Advantage (MA) business. This follows a civil inquiry into whether the company exaggerated patient diagnoses to secure higher payments for its MA plans, a serious allegation. UnitedHealth has denied any knowledge of a criminal investigation, so for now, that aspect remains speculative. These concerns come as the Centers for Medicare & Medicaid Services (CMS) plans to audit all Medicare Advantage programs, placing additional scrutiny on UnitedHealth. Given that the MA business is a critical part of UnitedHealthcare—one of the company's two core segments alongside Optum—this spotlight could have meaningful implications. In its first quarter 2025 earnings, UnitedHealthcare's revenues were $84.6 billion out of total revenues of $109.6 billion. As of Q1 2025, UnitedHealthcare had 8.2 million MA members, making up nearly 20% of the total domestic membership. In addition to mounting regulatory pressure, UnitedHealth's Medicare Advantage (MA) business is being squeezed by rising medical costs. An aging population is driving higher-than-expected utilization of healthcare services, while government reimbursement rates are slow to keep pace. For example, the planned 5.06% increase in reimbursement for 2026, though helpful, is unlikely to fully offset the surge in expenses, leaving MA providers like UnitedHealth in a difficult position. These cost pressures have already forced the company to lower its full-year 2025 earnings guidance. Compounding the situation are the lingering effects of the February 2024 ransomware attack on its Change Healthcare subsidiary, which exposed sensitive data of millions of patients. On top of that, the company is still reeling from the tragic assassination of former CEO Brian Thompson last December, adding further disruption during an already turbulent period. For investors, turbulent periods like this echo Warren Buffett's famous advice: 'Be fearful when others are greedy, and greedy when others are fearful.' UnitedHealth's newly reappointed CEO, Stephen J. Hemsley, is well-suited to lead through uncertainty, having already steered the company through the 2008 financial crisis during his previous tenure from 2006 to 2017. Importantly, UnitedHealth's business model is both defensive and diversified, extending well beyond its Medicare Advantage operations. Its Optum segment, which includes health services, pharmacy benefits management, and healthcare technology, is a major growth driver. In the first quarter alone, Optum's revenue rose by $2.8 billion to $63.9 billion. Optum's success also reinforces the MA business through its focus on value-based care, creating a potential flywheel effect that enhances overall efficiency and patient outcomes. And with powerful long-term tailwinds in the healthcare sector, particularly from an aging population, UnitedHealth—as the largest MA provider—remains well-positioned for future growth. On Wall Street, UNH sports a Moderate Buy consensus rating based on 19 Buy, six Hold, and one Sell ratings in the past three months. UNH's average price target of $380.59 implies a 28% upside potential over the next 12 months. Given the factors surrounding the stock, UNH has been subject to many rating downgrades this past month. For instance, HSBC analyst Sidharth Sahoo downgraded UNH to Sell due to several risks, including 'potential increases in the medical loss ratio, policy risks related to Optum Rx, and lower return on equity expectations. Additionally, the cancellation of 2025 earnings guidance has increased the downside risk for future earnings, and potential Medicaid funding cuts could further impact the company's financial performance.' Not all analysts share Sahoo's cautious outlook. JPMorgan's Lisa Gill maintains a Buy rating on UnitedHealth, viewing the recent stock decline as 'overdone.' She contends that The Guardian's report, which contributed to market volatility, misrepresents how UnitedHealth manages hospitalizations. In her view, the misconduct allegations don't hold up under scrutiny. Gill essentially dismisses the report's claims, emphasizing a logical rationale behind UnitedHealthcare incentivizing nursing facilities to reduce unnecessary hospitalizations, since it can lead to better outcomes and lower costs for all parties. That said, such programs must be implemented with care and integrity. Ethically, once a hospital transfer becomes medically necessary—say, in the case of stroke symptoms—it should never be delayed or denied. In response to the article, UnitedHealth issued a statement asserting that the Department of Justice had previously reviewed the matter and chose not to take further action. In summary, UnitedHealth's recent volatility could present a compelling opportunity for investors willing to ride out the turbulence. The company is clearly facing a tough stretch, with heightened regulatory scrutiny, rising medical costs, and the lasting impact of the Change Healthcare cyberattack creating significant near-term headwinds. However, looking beyond the immediate challenges, UnitedHealth's relatively conservative valuation and well-diversified business model provide a strong platform for long-term recovery. The road ahead may be uneven, but the company appears well-positioned to navigate the storm and emerge stronger on the other side. Disclaimer & DisclosureReport an Issue
Yahoo
2 days ago
- Business
- Yahoo
What to do if Brown Health, UnitedHealthcare don't strike a deal
PROVIDENCE, R.I. (WPRI) — Concerns are growing after thousands of patients enrolled in UnitedHealthcare's Medicare Advantage plans received notices that they will that they will no longer receive coverage at Brown University Health hospitals if the two sides don't agree on a new contract by July 1. The companies have been in negotiations since the beginning of the year but have yet to reach a deal, meaning patients may have to pay out of pocket at Rhode Island Hospital, Hasbro Children's Hospital, Newport Hospital and The Miriam Hospital. BACKGROUND: Some Medicare Advantage patients in RI may lose coverage at Brown Health hospitals Dr. Johnny Luo, a health insurance expert who runs Doctor's Choice, told 12 News that people shouldn't panic since there's still time for the two companies to come to an agreement. 'Brown University Health systems and UnitedHealthcare have a month to figure this out,' he said. Federal data shows that 60% of those enrolled in Medicare utilize Medicare Advantage plans in Rhode Island. UnitedHealthcare has not answered repeated requests for comment about the number of patients that could be affected. Dr. Luo said his company has been fielding questions from people who are concerned, but noted that there are ways to get a new insurance plan — if need be. 'Oftentimes, we'll see The Centers for Medicare and Medicaid Services (CMS), offer special election periods on a case-by-case basis for those folks throughout the year,' he said. The other option is to switch insurance plans during Medicare's open enrollment period that starts mid-October. 'This is the time when folks can either switch to another Medicare Advantage plan, or they can elect Part D prescription plan, go back to original Medicare,' Dr. Luo said. 'No time not to act': Neronha unveils plan to confront RI health care crisis Those who opt for original Medicare often will elect a Medicare supplement plan to help fill the coverage gap, according to Dr. Luo. He said Rhode Island is an underwriting state, which means people will have to go through a medical evaluation process and some could be denied coverage. 'If they have special needs when it comes to health care, preexisting conditions, they may be denied coverage into a supplemental plan coming from Medicare Advantage plan, so that's something to be aware of,' he explained. UnitedHealthcare and Brown Health have until June 30 to come up with a new deal. Brown Health has said the two companies mutually agreed to end their contract, while UnitedHealthcare has said they are still willing to come to the table. 12 Health: Paramedic creates support network for first responders Download the and apps to get breaking news and weather alerts. Watch or with the new . Follow us on social media: Close Thanks for signing up! Watch for us in your inbox. Subscribe Now Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
2 days ago
- Business
- Yahoo
Are you dually enrolled in Medicaid and Medicare? Here's what to know on Idaho switching contractors
Only 2,000 Idahoans dually enrolled in Medicare and Medicaid chose a specific insurance plan so far. But there's 90 days to decide. (Getty Images) Idaho is switching contractors that run health insurance plans for vulnerable patients. Starting June 1, the private health insurance companies running Idaho Medicaid and Medicare's plans will change to Molina Healthcare and UnitedHealthcare. That will only apply to the about 27,000 Idahoans who are dually eligible for Medicaid and Medicare, said Idaho Department of Health and Welfare spokesperson AJ McWhorter. Over half of them were already enrolled in an insurance plan run by a private company, called managed care. People dually enrolled in Medicare and Medicaid qualify for disabilities, low income and age. Many patients have already been automatically enrolled in one of the new duals insurance plans. But patients will have 90 days, or until Aug. 30, to pick, McWhorter told the Sun in an email. Only 2,000 people chose a specific insurance plan so far, after Health and Welfare sent out letters in March, he said on May 22. 'Many people haven't chosen a new plan because they like the plan they will be enrolled in if they do not make a selection. But we want to be sure that everyone who wants to make an active choice does so,' he said. Idaho's dual Medicaid and Medicare offers two types of plans. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX For people dually eligible, Medicaid generally covers costs not fully covered by Medicare, such as for nursing homes and home and community-based services, according to the federal Centers for Medicare and Medicaid Services. Both of the new Idaho companies, Molina and United, will be required to honor existing patient authorizations for the first 90 days of the contract, the Idaho Department of Health and Welfare says. Health and Welfare is winding down readiness reviews of the new companies and hasn't spotted any concerning issues, Idaho Medicaid Deputy Director Juliet Charron told the Idaho Capital Sun in a May 19 interview. 'Could there be bumps in the road? Of course,' she said. But that's why she said Idaho officials are communicating proactively. People who have questions or concerns should reach out to the Idaho Department of Health and Welfare, or United or Molina, she said. The Idaho Department of Health and Welfare has resources about the contract change available online on a frequently asked questions webpage. Patients can also contact Health and Welfare, or the new insurance companies. Here's how: Idaho Department of Health and Welfare: Website: Email: IdahoDuals@ Phone: 833-814-8568 UnitedHealthcare Website: Phone: 866-785-1628 for Medicaid participants, or 855-819-5909 for providers Molina Healthcare of Idaho: Website: Phone: 866-403-8293 for Medicaid participants, or 844-239-4914 for providers The health insurer Blue Cross of Idaho previously ran Idaho's dual Medicaid and Medicare plans. Last year, Idaho went out for a competitive bid for the contract for the first time. Initially, there was a six-month gap starting this June when Blue Cross's contract ended and United would've started, Idaho Reports reported in January. But since then, Health and Welfare has worked with the new insurance companies to start June 1. One United plan is available starting Jan. 1, 2026. SUPPORT: YOU MAKE OUR WORK POSSIBLE
Miami Herald
3 days ago
- Business
- Miami Herald
Congressional Dems ask judge to extend whistleblower case against UnitedHealth
More than two dozen Democrats in Congress, including U.S. Rep. Ilhan Omar of Minnesota, are asking a federal judge to let a whistleblower lawsuit move forward that alleges profiteering through the unlawful use of medical coding data by Minnesota-based UnitedHealth Group. The lawmakers argue in their May 15 court filing that a jury should be allowed to pass judgment on company practices the U.S. Department of Justice alleges have wrongfully inflated corporate earnings from the Medicare Advantage (MA) program by billions of dollars at taxpayer expense. A special master who examined the evidence recommended earlier this year that the long-running whistleblower lawsuit should be terminated via summary judgment. "It's way past time to rein in the wasteful and harmful practices committed by corporate health insurers in MA starting with UnitedHealthcare," Omar said in a statement to the Minnesota Star Tribune. "I joined the amicus brief to finally hold them accountable for stealing money from taxpayers and abusing the Medicare Advantage program." The lawsuit, which the Justice Department joined as a plaintiff in 2017, argues UnitedHealth Group engaged in one-sided reviews of medical charts to find evidence supporting higher payments for the company, but failed to use the same techniques to fix billing codes that would tend to lower the company's fees. In a statement, UnitedHealth Group pointed to a March report from a court-appointed special master that concluded the Justice Department's extensive efforts thus far had not recorded evidence of overpayments or wrongdoing by the company. Medicare Advantage is a privatized version of the federal health insurance program for seniors, where beneficiaries receive government-funded benefits via private insurance companies that manage the network of doctors and hospitals members can visit. UnitedHealth Group operates UnitedHealthcare, which runs the nation's largest MA plan. UnitedHealth notes that the federal Centers for Medicare and Medicaid Services provides extensive oversight of the program. "As evidenced by the recently released risk adjustment validation audits, our results continue to demonstrate the accuracy of our coding and the integrity of our practices," the company said in a statement to the Star Tribune. "It is unfortunate to see politically motivated attempts by longtime opponents of Medicare Advantage trying to extend a case that has been thoroughly reviewed and found to lack merit." In her March 3 ruling, Special Master Suzanne Segal found a "complete failure of evidence" from the Justice Department to support key aspects of its lawsuit, and wrote of the company's practices: "There simply was no fraud." "The money at issue is alleged overpayments the government claims United received as a result of submitting allegedly invalid diagnosis codes in connection with the Medicare Advantage program," Segal wrote. "The fatal flaw in the government's case is the complete absence of evidence of such overpayments, an essential element of the government's claim." The Justice Department said in April that Segal's conclusions were " fundamentally flawed," arguing a federal court in California should let the litigation proceed. Judge Fernando Olguin will consider the special master's report at a hearing scheduled for June 12 in the U.S. District Court for the Central District of California. It will be a pivotal moment in a case that dates back to 2011, when Benjamin Poehling, a former director of finance for UnitedHealth Group in Minnesota, filed his original whistleblower complaint. In Medicare Advantage, the government pays health insurers a per-member, per-month up-front payment to cover the cost of health care needs for beneficiaries, including higher fees for sicker populations. Health plans can increase their pay by submitting "risk adjustment" data on patients likely to need more care. The Justice Department argues that medical coding professionals hired by UnitedHealth reviewed charts to find data that would support higher payments to the company, but systematically ignored information that would have lowered fees from the government. "United cannot have it both ways," the lawmakers wrote in their amicus brief filed with the court. "It cannot argue, on one hand, that chart review is error prone and may be too complex to consistently identify unsupported codes, while simultaneously maintaining that its additional codes (and associated payments) are justifiable." The filing referenced the considerable scrutiny UnitedHealth has faced in recent years for its business practices in Medicare Advantage, including a 2023 report from the Office of the Inspector General at the U.S. Health and Human Services Department. The watchdog agency found UnitedHealth was the biggest user among insurers of questionable diagnosis data to boost Medicare Advantage payments. Earlier this month, the Wall Street Journal reported the Justice Department had launched a criminal fraud investigation of Medicare billing practices at UnitedHealth. "United is the world's most egregious upcoder and chief among the private MA insurers employing fraudulent and abusive tactics to retain funds that rightfully belong either in the Medicare Trust Funds or in the hands of the American taxpayers," the lawmakers said in their filing. Last week, Judge Olguin ordered UnitedHealth Group to file its response to the lawmakers' amicus brief by Friday. 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