Latest news with #privateCompanies
Yahoo
2 days ago
- Health
- Yahoo
Trump administration tiptoes into testing prior authorization in traditional Medicare
Traditional Medicare plan holders have typically not had to wait for prior authorization before receiving medical treatment. Until now. The Centers for Medicare & Medicaid Services (CMS) recently announced a new program to test prior authorization requirements for certain services in six states starting Jan. 1. The states — New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington — will apply prior authorization evaluations to more than a dozen services. CMS says the pilot program is intended to root out 'fraud, waste, and abuse,' but as Medicare Advantage members know well, prior authorization can lead to frustrating delays in care. How it works CMS will contract with private companies to deploy 'enhanced technologies, including artificial intelligence (AI)' to conduct the authorization reviews. It won't apply to in-patient or emergency services or treatments 'that would pose a substantial risk to patients if significantly delayed,' according to a CMS press release. Specific services that will require prior authorization are skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy. There is genuine concern about the costs of some of these items and services. A recent New York Times article highlighted pricey medical products, including paper-thin bandages made of dried bits of placenta, for Medicare patients. The Biden administration had approved a plan to limit Medicare's coverage of the bandages, known as skin substitutes, which were reportedly being sold for roughly $10,000 per square inch. An updated Medicare policy proposes setting a significantly lower payment rate. The new prior authorization program 'is focused on reducing wasteful spending, which is an important goal for Medicare,' Jeffrey Marr, a health economist at the Brown University School of Public Health, told Yahoo Finance. 'I expect that the use of prior authorization in this model is likely to reduce the overall level of Medicare spending,' he said. 'Selecting potentially low-value services is a critical part of setting up a well-functioning prior authorization system.' The key question for CMS to address is whether prior authorization can work in traditional Medicare in a way that does not deny or discourage high-value care that improves beneficiaries' health, Marr said. One red flag: 'The companies that will make the prior authorization decisions will be paid a percentage of the savings that they generate for Medicare. This creates an incentive for participants to deny a high share of services,' he said. Sign up for the Mind Your Money weekly newsletter By subscribing, you are agreeing to Yahoo's Terms and Privacy Policy Prior authorizations are part of the Medicare landscape How often do prior authorizations pop up for seniors with Medicare and Medicare Advantage plans? In traditional Medicare, services that often require prior authorization include certain outpatient hospital services, non-emergency ambulance transport, and durable medical equipment. For 2023, under 400,000 prior authorization reviews for traditional Medicare beneficiaries were submitted to CMS, according to KFF data. Medicare Advantage plans, which are offered by private insurers, are a different story. Almost all Medicare Advantage enrollees — 99% according to KFF research — must receive prior authorization for some services. These are typically higher-cost services, such as inpatient hospital stays, skilled nursing facility stays, chemotherapy, and other drugs. That common practice, combined with AI used to scan these requests, is a thorny issue. 'Prior authorization processes and requirements, including the use of artificial intelligence to review requests, may result in administrative hassles for providers, delays for patients in receiving necessary care, and in some instances, denials of medically necessary services, such as post-acute care,' according to Jeannie Fuglesten Biniek, co-author of the KFF report. To allay that fear, CMS noted in the announcement: 'While technology will support the review process, final decisions that a request for one of the selected services does not meet Medicare coverage requirements will be made by licensed clinicians, not machines.' The prior authorization program will not alter Medicare coverage or payment rules, for now, but other services may be added later. There has been pushback. More than a dozen members of Congress sent a letter on Aug. 7 to CMS administrator Dr. Memet Oz to urge him to 'put patients and providers first by cancelling' the model and requested more details about how the program will be implemented. 'The use of prior authorization in Medicare Advantage shows us that, in practice, [this proposal] will likely limit beneficiaries' access to care, increase burden on our already overburdened healthcare workforce, and create perverse incentives to put profit over patients,' the lawmakers wrote.A pivot in MA authorization In an odd juxtaposition, a week prior to trumpeting this new Medicare pre-authorization model, the administration announced that it had a non-binding commitment from insurance plans to reduce prior authorization in Medicare Advantage. In late June, the Department of Health and Human Services announced an initiative coordinated with companies including Aetna, Blue Cross Blue Shield, Humana, and UnitedHealthcare, to streamline prior authorization processes for patients covered by Medicare Advantage. Under the initiative, electronic prior authorization requests would become standardized by 2027. 'Pitting patients and their doctors against massive companies was not good for anyone,' US Health and Human Services Secretary Robert F. Kennedy, Jr. said in a statement. 'We are actively working with industry to make it easier to get prior authorization for common services such as diagnostic imaging, physical therapy, and outpatient surgery.' Oz added: 'These commitments represent a step in the right direction toward restoring trust, easing burdens on providers, and helping patients receive timely, evidence-based care.' Kerry Hannon is a Senior Columnist at Yahoo Finance. She is a career and retirement strategist and the author of 14 books, including the forthcoming "Retirement Bites: A Gen X Guide to Securing Your Financial Future," "In Control at 50+: How to Succeed in the New World of Work," and "Never Too Old to Get Rich." Follow her on Bluesky. Sign up for the Mind Your Money newsletter
Yahoo
2 days ago
- Health
- Yahoo
Trump administration tiptoes into testing prior authorization in traditional Medicare
Traditional Medicare plan holders have typically not had to wait for prior authorization before receiving medical treatment. Until now. The Centers for Medicare & Medicaid Services (CMS) recently announced a new program to test prior authorization requirements for certain services in six states starting Jan. 1. The states — New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington — will apply prior authorization evaluations to more than a dozen services. CMS says the pilot program is intended to root out 'fraud, waste, and abuse,' but as Medicare Advantage members know well, prior authorization can lead to frustrating delays in care. How it works CMS will contract with private companies to deploy 'enhanced technologies, including artificial intelligence (AI)' to conduct the authorization reviews. It won't apply to in-patient or emergency services or treatments 'that would pose a substantial risk to patients if significantly delayed,' according to a CMS press release. Specific services that will require prior authorization are skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy. There is genuine concern about the costs of some of these items and services. A recent New York Times article highlighted pricey medical products, including paper-thin bandages made of dried bits of placenta, for Medicare patients. The Biden administration had approved a plan to limit Medicare's coverage of the bandages, known as skin substitutes, which were reportedly being sold for roughly $10,000 per square inch. An updated Medicare policy proposes setting a significantly lower payment rate. The new prior authorization program 'is focused on reducing wasteful spending, which is an important goal for Medicare,' Jeffrey Marr, a health economist at the Brown University School of Public Health, told Yahoo Finance. 'I expect that the use of prior authorization in this model is likely to reduce the overall level of Medicare spending,' he said. 'Selecting potentially low-value services is a critical part of setting up a well-functioning prior authorization system.' The key question for CMS to address is whether prior authorization can work in traditional Medicare in a way that does not deny or discourage high-value care that improves beneficiaries' health, Marr said. One red flag: 'The companies that will make the prior authorization decisions will be paid a percentage of the savings that they generate for Medicare. This creates an incentive for participants to deny a high share of services,' he said. Sign up for the Mind Your Money weekly newsletter By subscribing, you are agreeing to Yahoo's Terms and Privacy Policy Prior authorizations are part of the Medicare landscape How often do prior authorizations pop up for seniors with Medicare and Medicare Advantage plans? In traditional Medicare, services that often require prior authorization include certain outpatient hospital services, non-emergency ambulance transport, and durable medical equipment. For 2023, under 400,000 prior authorization reviews for traditional Medicare beneficiaries were submitted to CMS, according to KFF data. Medicare Advantage plans, which are offered by private insurers, are a different story. Almost all Medicare Advantage enrollees — 99% according to KFF research — must receive prior authorization for some services. These are typically higher-cost services, such as inpatient hospital stays, skilled nursing facility stays, chemotherapy, and other drugs. That common practice, combined with AI used to scan these requests, is a thorny issue. 'Prior authorization processes and requirements, including the use of artificial intelligence to review requests, may result in administrative hassles for providers, delays for patients in receiving necessary care, and in some instances, denials of medically necessary services, such as post-acute care,' according to Jeannie Fuglesten Biniek, co-author of the KFF report. To allay that fear, CMS noted in the announcement: 'While technology will support the review process, final decisions that a request for one of the selected services does not meet Medicare coverage requirements will be made by licensed clinicians, not machines.' The prior authorization program will not alter Medicare coverage or payment rules, for now, but other services may be added later. There has been pushback. More than a dozen members of Congress sent a letter on Aug. 7 to CMS administrator Dr. Memet Oz to urge him to 'put patients and providers first by cancelling' the model and requested more details about how the program will be implemented. 'The use of prior authorization in Medicare Advantage shows us that, in practice, [this proposal] will likely limit beneficiaries' access to care, increase burden on our already overburdened healthcare workforce, and create perverse incentives to put profit over patients,' the lawmakers wrote.A pivot in MA authorization In an odd juxtaposition, a week prior to trumpeting this new Medicare pre-authorization model, the administration announced that it had a non-binding commitment from insurance plans to reduce prior authorization in Medicare Advantage. In late June, the Department of Health and Human Services announced an initiative coordinated with companies including Aetna, Blue Cross Blue Shield, Humana, and UnitedHealthcare, to streamline prior authorization processes for patients covered by Medicare Advantage. Under the initiative, electronic prior authorization requests would become standardized by 2027. 'Pitting patients and their doctors against massive companies was not good for anyone,' US Health and Human Services Secretary Robert F. Kennedy, Jr. said in a statement. 'We are actively working with industry to make it easier to get prior authorization for common services such as diagnostic imaging, physical therapy, and outpatient surgery.' Oz added: 'These commitments represent a step in the right direction toward restoring trust, easing burdens on providers, and helping patients receive timely, evidence-based care.' Kerry Hannon is a Senior Columnist at Yahoo Finance. She is a career and retirement strategist and the author of 14 books, including the forthcoming "Retirement Bites: A Gen X Guide to Securing Your Financial Future," "In Control at 50+: How to Succeed in the New World of Work," and "Never Too Old to Get Rich." Follow her on Bluesky. Sign up for the Mind Your Money newsletter Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Yahoo
2 days ago
- Health
- Yahoo
Trump administration tiptoes into testing prior authorization in traditional Medicare
Traditional Medicare plan holders have typically not had to wait for prior authorization before receiving medical treatment. Until now. The Centers for Medicare & Medicaid Services (CMS) recently announced a new program to test prior authorization requirements for certain services in six states starting Jan. 1. The states — New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington — will apply prior authorization evaluations to more than a dozen services. CMS says the pilot program is intended to root out 'fraud, waste, and abuse,' but as Medicare Advantage members know well, prior authorization can lead to frustrating delays in care. How it works CMS will contract with private companies to deploy 'enhanced technologies, including artificial intelligence (AI)' to conduct the authorization reviews. It won't apply to in-patient or emergency services or treatments 'that would pose a substantial risk to patients if significantly delayed,' according to a CMS press release. Specific services that will require prior authorization are skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy. There is genuine concern about the costs of some of these items and services. A recent New York Times article highlighted pricey medical products, including paper-thin bandages made of dried bits of placenta, for Medicare patients. The Biden administration had approved a plan to limit Medicare's coverage of the bandages, known as skin substitutes, which were reportedly being sold for roughly $10,000 per square inch. An updated Medicare policy proposes setting a significantly lower payment rate. The new prior authorization program 'is focused on reducing wasteful spending, which is an important goal for Medicare,' Jeffrey Marr, a health economist at the Brown University School of Public Health, told Yahoo Finance. 'I expect that the use of prior authorization in this model is likely to reduce the overall level of Medicare spending,' he said. 'Selecting potentially low-value services is a critical part of setting up a well-functioning prior authorization system.' The key question for CMS to address is whether prior authorization can work in traditional Medicare in a way that does not deny or discourage high-value care that improves beneficiaries' health, Marr said. One red flag: 'The companies that will make the prior authorization decisions will be paid a percentage of the savings that they generate for Medicare. This creates an incentive for participants to deny a high share of services,' he said. Sign up for the Mind Your Money weekly newsletter By subscribing, you are agreeing to Yahoo's Terms and Privacy Policy Prior authorizations are part of the Medicare landscape How often do prior authorizations pop up for seniors with Medicare and Medicare Advantage plans? In traditional Medicare, services that often require prior authorization include certain outpatient hospital services, non-emergency ambulance transport, and durable medical equipment. For 2023, under 400,000 prior authorization reviews for traditional Medicare beneficiaries were submitted to CMS, according to KFF data. Medicare Advantage plans, which are offered by private insurers, are a different story. Almost all Medicare Advantage enrollees — 99% according to KFF research — must receive prior authorization for some services. These are typically higher-cost services, such as inpatient hospital stays, skilled nursing facility stays, chemotherapy, and other drugs. That common practice, combined with AI used to scan these requests, is a thorny issue. 'Prior authorization processes and requirements, including the use of artificial intelligence to review requests, may result in administrative hassles for providers, delays for patients in receiving necessary care, and in some instances, denials of medically necessary services, such as post-acute care,' according to Jeannie Fuglesten Biniek, co-author of the KFF report. To allay that fear, CMS noted in the announcement: 'While technology will support the review process, final decisions that a request for one of the selected services does not meet Medicare coverage requirements will be made by licensed clinicians, not machines.' The prior authorization program will not alter Medicare coverage or payment rules, for now, but other services may be added later. There has been pushback. More than a dozen members of Congress sent a letter on Aug. 7 to CMS administrator Dr. Memet Oz to urge him to 'put patients and providers first by cancelling' the model and requested more details about how the program will be implemented. 'The use of prior authorization in Medicare Advantage shows us that, in practice, [this proposal] will likely limit beneficiaries' access to care, increase burden on our already overburdened healthcare workforce, and create perverse incentives to put profit over patients,' the lawmakers wrote.A pivot in MA authorization In an odd juxtaposition, a week prior to trumpeting this new Medicare pre-authorization model, the administration announced that it had a non-binding commitment from insurance plans to reduce prior authorization in Medicare Advantage. In late June, the Department of Health and Human Services announced an initiative coordinated with companies including Aetna, Blue Cross Blue Shield, Humana, and UnitedHealthcare, to streamline prior authorization processes for patients covered by Medicare Advantage. Under the initiative, electronic prior authorization requests would become standardized by 2027. 'Pitting patients and their doctors against massive companies was not good for anyone,' US Health and Human Services Secretary Robert F. Kennedy, Jr. said in a statement. 'We are actively working with industry to make it easier to get prior authorization for common services such as diagnostic imaging, physical therapy, and outpatient surgery.' Oz added: 'These commitments represent a step in the right direction toward restoring trust, easing burdens on providers, and helping patients receive timely, evidence-based care.' Kerry Hannon is a Senior Columnist at Yahoo Finance. She is a career and retirement strategist and the author of 14 books, including the forthcoming "Retirement Bites: A Gen X Guide to Securing Your Financial Future," "In Control at 50+: How to Succeed in the New World of Work," and "Never Too Old to Get Rich." Follow her on Bluesky. Sign up for the Mind Your Money newsletter Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Yahoo
05-07-2025
- Business
- Yahoo
While private companies own 23% of EG Industries Berhad (KLSE:EG), individual investors are its largest shareholders with 32% ownership
Significant control over EG Industries Berhad by individual investors implies that the general public has more power to influence management and governance-related decisions A total of 13 investors have a majority stake in the company with 51% ownership 19% of EG Industries Berhad is held by insiders Trump has pledged to "unleash" American oil and gas and these 15 US stocks have developments that are poised to benefit. To get a sense of who is truly in control of EG Industries Berhad (KLSE:EG), it is important to understand the ownership structure of the business. We can see that individual investors own the lion's share in the company with 32% ownership. That is, the group stands to benefit the most if the stock rises (or lose the most if there is a downturn). And private companies on the other hand have a 23% ownership in the company. Let's delve deeper into each type of owner of EG Industries Berhad, beginning with the chart below. View our latest analysis for EG Industries Berhad Many institutions measure their performance against an index that approximates the local market. So they usually pay more attention to companies that are included in major indices. As you can see, institutional investors have a fair amount of stake in EG Industries Berhad. This can indicate that the company has a certain degree of credibility in the investment community. However, it is best to be wary of relying on the supposed validation that comes with institutional investors. They too, get it wrong sometimes. When multiple institutions own a stock, there's always a risk that they are in a 'crowded trade'. When such a trade goes wrong, multiple parties may compete to sell stock fast. This risk is higher in a company without a history of growth. You can see EG Industries Berhad's historic earnings and revenue below, but keep in mind there's always more to the story. Hedge funds don't have many shares in EG Industries Berhad. With a 10.0% stake, CEO Pang Kang is the largest shareholder. Qyh Capital Sdn. Bhd. is the second largest shareholder owning 6.7% of common stock, and KAF Investment Funds Bhd. holds about 4.9% of the company stock. After doing some more digging, we found that the top 13 have the combined ownership of 51% in the company, suggesting that no single shareholder has significant control over the company. Researching institutional ownership is a good way to gauge and filter a stock's expected performance. The same can be achieved by studying analyst sentiments. As far as we can tell there isn't analyst coverage of the company, so it is probably flying under the radar. The definition of an insider can differ slightly between different countries, but members of the board of directors always count. Management ultimately answers to the board. However, it is not uncommon for managers to be executive board members, especially if they are a founder or the CEO. I generally consider insider ownership to be a good thing. However, on some occasions it makes it more difficult for other shareholders to hold the board accountable for decisions. Our most recent data indicates that insiders own a reasonable proportion of EG Industries Berhad. Insiders have a RM211m stake in this RM1.1b business. This may suggest that the founders still own a lot of shares. You can click here to see if they have been buying or selling. With a 32% ownership, the general public, mostly comprising of individual investors, have some degree of sway over EG Industries Berhad. This size of ownership, while considerable, may not be enough to change company policy if the decision is not in sync with other large shareholders. It seems that Private Companies own 23%, of the EG Industries Berhad stock. It's hard to draw any conclusions from this fact alone, so its worth looking into who owns those private companies. Sometimes insiders or other related parties have an interest in shares in a public company through a separate private company. It's always worth thinking about the different groups who own shares in a company. But to understand EG Industries Berhad better, we need to consider many other factors. Consider for instance, the ever-present spectre of investment risk. We've identified 1 warning sign with EG Industries Berhad , and understanding them should be part of your investment process. Of course, you might find a fantastic investment by looking elsewhere. So take a peek at this free list of interesting companies. NB: Figures in this article are calculated using data from the last twelve months, which refer to the 12-month period ending on the last date of the month the financial statement is dated. This may not be consistent with full year annual report figures. Have feedback on this article? Concerned about the content? Get in touch with us directly. Alternatively, email editorial-team (at) article by Simply Wall St is general in nature. We provide commentary based on historical data and analyst forecasts only using an unbiased methodology and our articles are not intended to be financial advice. It does not constitute a recommendation to buy or sell any stock, and does not take account of your objectives, or your financial situation. We aim to bring you long-term focused analysis driven by fundamental data. Note that our analysis may not factor in the latest price-sensitive company announcements or qualitative material. Simply Wall St has no position in any stocks mentioned. Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Yahoo
05-07-2025
- Business
- Yahoo
While private companies own 23% of EG Industries Berhad (KLSE:EG), individual investors are its largest shareholders with 32% ownership
Significant control over EG Industries Berhad by individual investors implies that the general public has more power to influence management and governance-related decisions A total of 13 investors have a majority stake in the company with 51% ownership 19% of EG Industries Berhad is held by insiders Trump has pledged to "unleash" American oil and gas and these 15 US stocks have developments that are poised to benefit. To get a sense of who is truly in control of EG Industries Berhad (KLSE:EG), it is important to understand the ownership structure of the business. We can see that individual investors own the lion's share in the company with 32% ownership. That is, the group stands to benefit the most if the stock rises (or lose the most if there is a downturn). And private companies on the other hand have a 23% ownership in the company. Let's delve deeper into each type of owner of EG Industries Berhad, beginning with the chart below. View our latest analysis for EG Industries Berhad Many institutions measure their performance against an index that approximates the local market. So they usually pay more attention to companies that are included in major indices. As you can see, institutional investors have a fair amount of stake in EG Industries Berhad. This can indicate that the company has a certain degree of credibility in the investment community. However, it is best to be wary of relying on the supposed validation that comes with institutional investors. They too, get it wrong sometimes. When multiple institutions own a stock, there's always a risk that they are in a 'crowded trade'. When such a trade goes wrong, multiple parties may compete to sell stock fast. This risk is higher in a company without a history of growth. You can see EG Industries Berhad's historic earnings and revenue below, but keep in mind there's always more to the story. Hedge funds don't have many shares in EG Industries Berhad. With a 10.0% stake, CEO Pang Kang is the largest shareholder. Qyh Capital Sdn. Bhd. is the second largest shareholder owning 6.7% of common stock, and KAF Investment Funds Bhd. holds about 4.9% of the company stock. After doing some more digging, we found that the top 13 have the combined ownership of 51% in the company, suggesting that no single shareholder has significant control over the company. Researching institutional ownership is a good way to gauge and filter a stock's expected performance. The same can be achieved by studying analyst sentiments. As far as we can tell there isn't analyst coverage of the company, so it is probably flying under the radar. The definition of an insider can differ slightly between different countries, but members of the board of directors always count. Management ultimately answers to the board. However, it is not uncommon for managers to be executive board members, especially if they are a founder or the CEO. I generally consider insider ownership to be a good thing. However, on some occasions it makes it more difficult for other shareholders to hold the board accountable for decisions. Our most recent data indicates that insiders own a reasonable proportion of EG Industries Berhad. Insiders have a RM211m stake in this RM1.1b business. This may suggest that the founders still own a lot of shares. You can click here to see if they have been buying or selling. With a 32% ownership, the general public, mostly comprising of individual investors, have some degree of sway over EG Industries Berhad. This size of ownership, while considerable, may not be enough to change company policy if the decision is not in sync with other large shareholders. It seems that Private Companies own 23%, of the EG Industries Berhad stock. It's hard to draw any conclusions from this fact alone, so its worth looking into who owns those private companies. Sometimes insiders or other related parties have an interest in shares in a public company through a separate private company. It's always worth thinking about the different groups who own shares in a company. But to understand EG Industries Berhad better, we need to consider many other factors. Consider for instance, the ever-present spectre of investment risk. We've identified 1 warning sign with EG Industries Berhad , and understanding them should be part of your investment process. Of course, you might find a fantastic investment by looking elsewhere. So take a peek at this free list of interesting companies. NB: Figures in this article are calculated using data from the last twelve months, which refer to the 12-month period ending on the last date of the month the financial statement is dated. This may not be consistent with full year annual report figures. Have feedback on this article? Concerned about the content? Get in touch with us directly. Alternatively, email editorial-team (at) article by Simply Wall St is general in nature. We provide commentary based on historical data and analyst forecasts only using an unbiased methodology and our articles are not intended to be financial advice. It does not constitute a recommendation to buy or sell any stock, and does not take account of your objectives, or your financial situation. We aim to bring you long-term focused analysis driven by fundamental data. Note that our analysis may not factor in the latest price-sensitive company announcements or qualitative material. Simply Wall St has no position in any stocks mentioned.
