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Is 935 million enough to send a message, we may soon find out

Great article regarding the 7 years of CMS non compliance - all under Gail, Fiona and Gloria’s watch. Be clear this is not a difference of opinion on what it takes to be CMS compliant, I believe there were decisions made that it was easier to just fake it and see what they could get away; it was cheaper to risk non compliance than to spend the money to get the data in order. Why won’t they let Pete testify? Doesn’t sound transparent or ethical and it is not good leadership. The Board members who weren’t part of the FA stage need to hold those that were accountable and make some changes cause they are about to enter the FO stage.

https://www.healthcare-brew.com/stories/2026/05/04/elevance-estimates-935m-avoid-CMS-sanctions


CMS Sanction

https://www.cms.gov/medicare/audits-compliance/part-c-d/part-c-and-part-d-enforcement-actions/elevancehealthsanction02272026

ElevanceHealthSanction02272026

Dynamic List Information
Dynamic List Data
Date Action Taken
2026-02-27
Organization Name
Elevance Health, Inc.
Action Taken
Suspension of Enrollment
Basis for Action
Contract Administration
Effective Date
2026-02-27


Are you buying this?

A new report released by the bipartisan Senate Joint Economic Committee (JEC) on Tuesday found that overpaying for Medicare Advantage (MA) plans caused Medicare Part B premiums to rise across the board.

According to the JEC’s report, overpayments to MA plans caused standard monthly Medicare Part B premiums to go from $185 in 2025 to $203 in 2026.

The report defined “overpayments” as the difference between what the federal government government paid for MA plans versus Traditional Medicare (TM) plans. When payments to MA plans exceeds those for TM plans, premiums go up for both groups.

In 2025, MA plans were paid $84 billion more than it would have cost to cover the same amount of beneficiaries with TM plans, an average of 120 percent more.

Medicare Part B covers medically necessary services like doctors visits, supplies and some outpatient prescriptions as well as preventive services. Roughly 63 million people are enrolled in Medicare Part B and a little more than half are on Medicare Advantage, which combines both Part A and Part B.
The JEC further noted that the burden of MA overpayments are spread unevenly across the country as some districts and states have lower rates of MA enrollment. The report gave the example of Wyoming, where only 21 percent of Medicare beneficiaries are enrolled in MA, estimating that payers in the state will pay $25.4 million in excess premiums, with most of that from TM enrollees.

“Let’s be honest about the math, when Medicare Advantage is overpaid, that money doesn’t just disappear, it shows up in the Medicare Part B premiums seniors pay every month, including those paid by traditional Medicare beneficiaries who are not getting extra benefits,” said JEC Chair David Schweikert (R-Ariz.) said in a statement.

“If Congress is serious about affordability, fiscal responsibility, and fairness, we must take a hard look at Medicare Advantage and make sure the rules are the same for everyone,” he continued.

“Today, between aggressive upcoding, questionable quality bonuses, and structural overpayments in Medicare Advantage, seniors who stay in traditional Medicare are effectively subsidizing the system. That’s not sustainable, it’s not fair, and it can be reformed.”


Michigan: This Is What Corporate Negligence Looks Like

Humana has reached rock bottom, and that’s not an exaggeration.

SNP leadership has taken on a Michigan contract that is clearly beyond their operational capacity, and frontline associates are the ones being forced to absorb the fallout.

We received 7 hours of training for work that realistically requires at least a week to do safely and competently. Yet we are now expected to call members, keep them on the phone for two hours, complete over 100 assessment questions, conduct a full care plan review, complete ICT documentation, and do this three times per day.

There is no raise. No incentive. Instead, mandatory overtime to compensate for leadership’s decisions.

This is not sustainable. It is not responsible. It compromises the quality of care our vulnerable members deserve.

And let’s be clear: this is not what work-life balance looks like. This is not how you support healthcare professionals. This is burnout by design.
Associates are exhausted, frustrated, and deeply concerned about the direction this is going.

#CMS #Michigan #MDHHS


TMs be sure to destroy your SMs on their Peakon Surveys next month

TMs be sure to absolutely just blast your SM on the Peakon Survey. I know some of them are decent but it's about a lot more than that. You want to make CMs and VPs squirm. Put in the comments, be harsh and do not go easy. Answer everything with zeros and be as spiteful as you can. Understand the surveys are not about making changes, it's about how effective the propaganda is and it lets them judge how far they can pressure you before things explode. Do not assume good intentions, under no circumstances. That place is an evil toxic he-l hole!