Podcasts about Medicare Advantage

Why UnitedHealth's Criminal Investigation Is Fueling the Cash Practice Movement In this episode, Danny, founder of PT Biz, exposes the major criminal investigation into UnitedHealth and breaks down how their alleged Medicare Advantage fraud is creating the perfect storm for the rise of cash-based healthcare. With the Department of Justice involved and billions of taxpayer dollars at stake, this could be one of the biggest health insurance scandals of our time. More importantly, Danny explains how this chaos is a massive opportunity for providers who want to ditch the insurance system and build profitable, transparent, patient-first practices outside the traditional model. Topics Covered Why UnitedHealth is being criminally investigated by the DOJ How Medicare Advantage "upcoding" works—and why it's fraud Why more people are abandoning traditional insurance plans The connection between high deductibles and patient behavior How cash-based and out-of-network clinics are thriving in the mess The mindset shift from sick care to proactive health investment Why this is the best time to start or scale a cash-based clinic Common fears about market saturation—and why they're unfounded Key Quote “People used to think I was a jackass for not taking insurance. Now they're looking for clinics like this on purpose.” Resources & Links Visit PT Biz – See how we help cash-based and hybrid practices grow Book a Free Strategy Call – Speak with our team and get clear on your next steps Subscribe on YouTube – Get breakdowns, insights, and client case studies Read the PT Biz Book – Learn how to build your own cash-based practice Final Thought The system is broken—and people know it. With trust in insurance companies at an all-time low, more patients are seeking alternatives that put their health and dollars first. If you've ever considered going cash-based or out-of-network, there's never been a better time to start.

Dr. John Sweetenham and Dr. Erika Hamilton highlight key abstracts that were presented at ASCO25, including advances in breast and pancreatic cancers as well as remarkable data from the use of structured exercise programs in cancer care. Transcript Dr. Sweetenham: Hello, and welcome to the ASCO Daily News Podcast. I'm your host, Dr. John Sweetenham. Today, we'll be discussing some of the key advances and novel approaches in cancer care that were presented at the 2025 ASCO Annual Meeting. I'm delighted to be joined again by the chair of the Meeting's Scientific Program, Dr. Erika Hamilton. She is a medical oncologist and director of breast cancer and gynecologic cancer research at the Sarah Cannon Research Institute in Nashville, Tennessee.  Our full disclosures are available in the transcript of this episode. Dr. Hamilton, congratulations on a fantastic meeting. From the practice-changing science to the world-renowned speakers at this year's Meeting, ASCO25 really reflected the amazing progress we're seeing in oncology today and the enormous opportunities that lie ahead of us. And thanks for coming back on to the podcast today to discuss some of these advances. Dr. Hamilton: Thanks, Dr. Sweetenham. I'm happy to join you today. It really was an impactful ASCO Annual Meeting. I probably am biased, but some great research was presented this year, and I heard lots of great conversations happening while we were there. Dr. Sweetenham: Yeah, absolutely. There was a lot of buzz, as well as a lot of media buzz around the meeting this year, and I think that's probably a good place to start. So I'd like to dive into abstract number LBA3510. This was the CHALLENGE trial, which created a lot of buzz at the meeting and subsequently in the media. This is the study that was led by the NCI Canada Clinical Trials Group, which was the first randomized phase 3 trial in patients with stage III and high-risk stage II colon cancer, which demonstrated that a post-treatment structured exercise program is both feasible and effective in improving disease-free survival in this patient group. The study was performed over a long period of time and in many respects is quite remarkable. So, I wonder if you could give us your thoughts about this study and whether you think that this means that our futures are going to be full of structured exercise programs for those patients who may benefit. Dr. Hamilton: It's a fantastic question. I think that this abstract did create a lot of buzz. We were very excited when we read it. It was highlighted in one of the Clinical Science Symposium sessions. But briefly, this was a phase 3 randomized trial. It was conducted at 55 centers, so really a broad experience, and patients that had resected colon cancer who completed adjuvant therapy were allowed to participate. There were essentially 2 groups: a structured exercise program, called ‘the exercise group,' or health education materials alone, so that was called just ‘the health education group.' And this was a 3-year intervention, so very high quality. The primary end point, as you mentioned, was disease-free survival. This actually accrued from 2009 to 2024, so quite a lift, and almost 900 patients underwent randomization to the exercise group or the health education group. And at almost 8 years of follow-up, we saw that the disease-free survival was significantly longer in the exercise group than the health education group. This was essentially 80.3% of patients were disease-free in exercise and 73.9% in the health education group. So a difference of over 6 percentage points, which, you know, at least in the breast cancer world, we make decisions about whether to do chemotherapy or not based on these kind of data. We also looked at overall survival in the exercise group and health education group, and the 8-year overall survival was 90.3% in the exercise group and 83.2% in the health education group. So this was a difference of 7.1%. Still statistically significant. I think this was really a fantastic effort over more than a decade at over 50 institutions with almost 900 patients, really done in a very systematic, high-intervention way that showed a fantastic result. Absolutely generalizable for patients with colon cancer. We have hints in other cancers that this is beneficial, and frankly, for our patients for other comorbidities, such as cardiovascular, etc., I really think that this is an abstract that deserved the press that it received. Dr. Sweetenham: Yeah, absolutely, and it is going to be very interesting, I think, over the next 2 or 3 years to see how much impact this particular study might have on programs across the country and across the world actually, in terms of what they do in this kind of adjuvant setting for structured exercise. Dr. Hamilton: Absolutely.  So let's move on to Abstract 3006. This was an NCI-led effort comparing genomic testing using ctDNA and tissue from patients with less common cancers who were enrolled in but not eligible for a treatment arm of the NCI-MATCH trial. Tell us about your takeaways from this study. Dr. Sweetenham: Yeah, so I thought this was a really interesting study based, as you said, on NCI-MATCH. And many of the listeners will probably remember that the original NCI-MATCH study screened almost 6,000 patients to assess eligibility for those who had an actionable mutation. And it turned out that about 60% of the patients who went on to the study had less common tumors, which were defined as anything other than colon, rectum, breast, non–small cell lung cancer, or prostate cancer. And most of those patients lacked an eligible mutation of interest and so didn't get onto a trial therapy. But with a great deal of foresight, the study group had actually collected plasma samples from these patients so that they would have the opportunity to look at circulating tumor DNA profiles with the potential being that this might be another way for testing for clinically relevant mutations in some of these less common cancer types. So initially, they tested more than 2,000 patients, and to make a somewhat complicated story short, there was a subset of five histologies with a larger representation in terms of sample size. And these were cholangiocarcinoma, small cell lung cancer, esophageal cancer, pancreatic, and salivary gland cancer. And in those particular tumors, when they compared the ctDNA sequencing with the original tumor, there was a concordance there of around 84%, 85%. And in the presentation, the investigators go on to list the specific mutated genes that were identified in each of those tumors. But I think that the other compelling part of this study from my perspective was not just that concordance, which suggests that there's an opportunity there for the use of ctDNA instead of tumor biopsies in some of these situations, but what was also interesting was the fact that there were several clinically relevant mutations which were detected only in the circulating tumor DNA. And a couple of examples of those included IDH1 for cholangiocarcinoma, BRAF and p53 in several histologies, and microsatellite instability was most prevalent in small cell lung cancer in the ctDNA. So I think that what this demonstrates is that liquid biopsy is certainly a viable screening option for patients who are being assessed for matching for targeted therapies in clinical trials. The fact that some of these mutations were only seen in the ctDNA and not in the primary tumor specimen certainly suggests that there's some tumor heterogeneity. But I think that for me, the most compelling part of this study was the fact that many of these mutations were only picked up in the plasma. And so, as the authors concluded, they believe that a comprehensive gene profiling with circulating tumor DNA probably should be included as a primary screening modality in future trials of targeted therapy of this type. Dr. Hamilton: Yeah, I think that that's really interesting and mirrors a lot of data that we've been seeing. At least in breast cancer, you know, we still do a biopsy up front to make sure that our markers, we're still treating the right disease that we think we are. But it really speaks to the utility of using ctDNA for serial monitoring and the emergence of mutations. Dr. Sweetenham: Absolutely. And you mentioned breast cancer, and so I'd like to dwell on that for a moment here because obviously, there was a huge amount of exciting breast cancer data presented at the meeting this year. And in particular, I'd like to ask you about LBA1008, the DESTINY-Breast09 clinical trial, which I think has the potential to establish a new first-line standard of care for metastatic HER2+ breast cancer. And that's an area where we haven't seen a whole lot of innovation for around a decade now. So can you give us some of the highlights of this trial and what your thinking is, having seen the results? Dr. Hamilton: Yeah, absolutely. So this was a trial in the first-line metastatic HER2 setting. So this was looking at trastuzumab deruxtecan. We certainly have had no shortage of reports around this drug, initially approved for later lines. DESTINY-Breast03 brought it into our second-line setting for HER2+ disease and we're now looking at DESTINY-Breast09 in first-line. So this actually was a 3-arm trial where patients were randomized 1:1:1 against standard taxane/trastuzumab/pertuzumab in one arm; trastuzumab deruxtecan with pertuzumab in another arm; and then a third arm, trastuzumab deruxtecan alone. And what we did not see reported was that trastuzumab deruxtecan-alone arm. But we did have reports from the trastuzumab deruxtecan plus pertuzumab versus the chemo/trastuzumab/pertuzumab. And what we saw was a statistically significant improvement in median progression-free survival, 26.9 months up to 40.7, so an improvement of 13.8 months, over a year in PFS. Not to mention that we're now in the 40-month range for PFS in first-line disease. Really, across all subgroups, we really weren't able to pick out a subset of patients that did not benefit. We did see about a 12% ILD rate with trastuzumab deruxtecan. That really is on par with what we've seen in other studies, around 10%-15%. I think that this is going to become a new standard of care in the first-line. I think it did leave some unanswered questions. We saw some data from the PATINA trial this past San Antonio Breast, looking at the addition of endocrine therapy with or without a CDK4/6 inhibitor, palbociclib, for those patients that also have ER+ disease, after taxane has dropped out in the first-line setting. So how we're going to kind of merge all this together is, I suspect that there are going to be patients that we or they just don't have the appetite to continue 3 to 4 years of trastuzumab deruxtecan. And so we're probably going to be looking at a maintenance-type strategy for them, maybe integrating the PATINA data there. But how we really put this into practice in the first-line setting and if or when we think about de-escalating down from trastuzumab deruxtecan to antibody therapy are some lingering questions. Dr. Sweetenham: Okay, so certainly is going to influence practice, but watch this space for a little bit longer, it sounds as though that's what you're saying. Dr. Hamilton: Absolutely.  So let's move on to GI cancer. Abstract 4006 reported preliminary results from the randomized phase 2 study of elraglusib in combination with gemcitabine/nab-paclitaxel versus the chemo gemcitabine/nab-paclitaxel alone in patients with previously untreated metastatic pancreatic cancer. Can you tell us more about this study? Dr. Sweetenham: Yeah, absolutely. As you mentioned, elraglusib is actually a first-in-class inhibitor of GSK3-beta, which has multiple potential actions in pancreatic cancer. But the drug itself may be involved in mediating drug resistance as well as in some tumor immune response modulation. Some of that's not clearly understood, I believe, right now. But certainly, preclinical data suggests that the drug may be effective in preclinical models and may also be effective in combination with chemotherapy and potentially with immune-modulating agents as well. So this particular study, as you said, was an open-label, randomized phase 2 study in which patients with pancreatic cancer were randomized 2:1 in favor of the elraglusib plus GMP—gemcitabine and nab-paclitaxel—versus the chemotherapy alone. And upon completion of the study, which is not right now, median overall survival was the primary end point, but there are a number of other end points which I'll talk about in just a moment. But the sample size was planned to be around 207 patients. The primary analysis included 155 patients in the combination arm versus 78 patients in the gemcitabine/nab-paclitaxel arm. Overall, the 1-year overall survival rate was 44.1% for the patients in the elraglusib-containing arm versus 23.0% in the patients receiving gemcitabine/nab-paclitaxel only. When they look at the median overall survival, it was 9.3 months for the experimental arm versus 7.2 months for chemotherapy alone. So put another way, there's around a 37% reduction in the risk of death with the use of this combination arm. The treatment was overall well-tolerated. There were some issues with grade 1 to 2 transient visual impairment in a large proportion of the patients. The most common treatment-related adverse effects with the elraglusib/GMP combination was transient visual impairment, which affected around 60% of the patients. Most of the more serious treatment-related adverse events included neutropenia, anemia, and fatigue in 50%, 25%, and 16% of the patients, respectively. So the early results from this study show a significant benefit for 1-year overall survival and for median overall survival with, as I mentioned above, a significant reduction in the risk of death. The authors went on to mention that the median overall survival for the control arm in this study is somewhat lower than in other comparable trials, but they think that this may be related to a more advanced disease burden in this particular study. Of interest to me was that right now: there is no apparent difference in progression-free survival between the 2 arms of this study. The authors described this as potentially indicating that this may be related in some way to immune modulation and immune effects on the tumor, which, if I'm completely honest, I don't totally understand. And so, the improvement in overall survival, as far as I can see at the moment, is not matched by an improvement in progression-free survival. So I think we probably need to wait for more time to elapse to see what happens with the study. And so, I think it certainly is an interesting study, and the results are intriguing, but I think it's probably a little early for it to actually shift the treatment paradigm in this disease. Dr. Hamilton: Fantastic. I think we've been waiting for advances in pancreatic cancer for a long time, but this, not unlike others, we learn more and then learn more we don't realize, so. Dr. Sweetenham: Right. Let's shift gears at this point and talk about a couple of other abstracts in kind of a very different space. Let's start out with symptom management for older adults with cancer. We know that undertreated symptoms are common among the older patient population, and Abstract 11002 reported on a randomized trial that demonstrated the effects of remote monitoring for older patients with cancer in terms of kind of symptoms and so on. Can you tell us a little bit about this study and whether you think this approach will potentially improve care for older patients? Dr. Hamilton: Yeah, I really liked this abstract. It was conducted through the Veterans Affairs, and it was based in California, which I'm telling you that because it's going to have a little bit of an implication later on. But essentially, adults that were 75 years or older who were Medicare Advantage beneficiaries were eligible to participate. Forty-three clinics in Southern California and Arizona, and patients were randomized either into a control group of usual clinic care alone, or an intervention group, which was usual care plus a lay health worker-led proactive telephone-based weekly symptom assessment, and this was for 12 months using the validated Edmonton Symptom Assessment System. So, there was a planned enrollment of at least 200 patients in each group. They successfully met that. And this lay health worker reviewed assessments with a physician assistant, who conducted follow-up for symptoms that changed by 2 points from a prior assessment or were rated 4 or greater. So almost a triage system to figure out who needed to be reached out to and to kind of work on symptoms. What I thought was fantastic about this was it was very representative of where it enrolled. There were actually about 50% of patients enrolled here that were Hispanic or Latinos. So some of our underserved populations and really across a wide variety of tumor types. They found that the intervention group had 53% lower odds of emergency room use, 68% lower odds of hospital use than the control group. And when they translated this to actual total cost of care, this was a savings of about $12,000 U.S. per participant and 75% lower odds of a death in an acute care facility. So I thought this was really interesting for a variety of reasons. One, certainly health care utilization and cost, but even more so, I think any of our patients would want to prevent hospitalizations and ER visits. Normally, that's not a fantastic experience having to feel poorly enough that you're in the emergency room or the hospital. And really showing in kind of concrete metrics that we were able to decrease this with this intervention. In terms of sustainability and scalability, I think the question is really the workforce to do this. Obviously, you know, this is going to take dedicated employees to have the ability to reach out to these patients, etc., but I think in value-based care, there's definitely a possibility of having reimbursement and having the funds to institute a program like this. So, definitely thought-provoking, and I hope it leads to more interventions. Dr. Sweetenham: Yeah, we've seen, over several years now, many of these studies which have looked at remote symptom monitoring and so on in this patient population, and many of them do show benefits for that in kinds of end points, not the least in this study being hospitalization and emergency room avoidance. But I think the scalability and personnel issue is a huge one, and I do wonder at some level whether we may see some AI-based platforms coming along that could actually help with this and provide interactions with these patients outside of actual real people, or at least in combination with real people. Dr. Hamilton: Yeah, that's a fantastic point.  So let's talk a little bit about clinical trials. So eligibility assessment for oncology clinical trials, or prescreening, really relies on manual review of unstructured clinical notes. It's time-consuming, it's prone to errors, and Abstract 1508 reported on the final analysis of a randomized trial that looked at the effect of human-AI teams prescreening for clinical trial eligibility versus human-only or AI-only prescreening. So give us more good news about AI. What did the study find? Dr. Sweetenham: Yeah, this is a really, a really interesting study. And of course, any of us who have ever been involved in clinical trials will know that accrual is always a problem. And I think most centers have attempted, and some quite successfully managed to develop prescreening programs so that patients are screened by a health care provider or health care worker prior to being seen in the clinic, and the clinical investigator will then already know whether they're going to be eligible for a trial or not. But as you've already said, it's a slow process. It's typically somewhat inefficient and requires a lot of time on the part of the health care workers to actually do this in a successful way. And so, this was a study from Emory University where they took three models of ways in which they could assess the accuracy of the prescreening of charts for patients who are going to be considered for clinical trials. One of these was essentially the regular way of having two research coordinators physically abstract the charts. The second one was an AI platform which would extract longitudinal EHR data. And then the third one was a combination of the two. So the AI would be augmented by the research coordinator or the other way around. As a gold standard, they had three independent oncology reviewers who went through all of these charts to provide what they regarded as being the benchmark for accuracy. In a way, it's not a surprise to me because I think that a number of other systems which have used this combination of human verification of AI-based tools, it actually ultimately concluded that the combination of the two in terms of chart accuracy was for the most part better than either one individually, either the research coordinator or the AI alone. So I'll give you just a few examples of where specifically that mattered. The human plus AI platform was more accurate in terms of tumor staging, in terms of identifying biomarker testing and biomarker results, as well as biomarker interpretation, and was also superior in terms of listing medications. There are one or two other areas where either the AI alone was somewhat more accurate, but the significant differences were very much in favor of a combination of human + AI screening of these patient charts. So, in full disclosure, this didn't save time, but what the authors reported was that there were definite efficiency gains, and presumably this would actually become even more improved once the research coordinators were somewhat more comfortable and at home with the AI tool. So, I thought it was an interesting way of trying to enhance clinical trial accrual up front by this combination of humans and technology, and I think it's going to be interesting to see if this gets adopted at other centers in the future. Dr. Hamilton: Yeah, I think it's really fascinating, all the different places that we can be using AI, and I love the takeaway that AI and humans together are better than either individually. Dr. Sweetenham: Absolutely.  Thanks once again, Dr. Hamilton, for sharing your insights with us today and for all of the incredible work you did to build a robust program. And also, congratulations on what was, I think, a really remarkable ASCO this year, one of the most exciting for some time, I think. So thank you again for that. Dr. Hamilton: Thanks so much. It was really a pleasure to work on ASCO 2025 this year. Dr. Sweetenham: And thank you to our listeners for joining us today. You'll find links to all the abstracts we discussed today in the transcript of this episode. Be sure to catch up on all of our coverage from the Annual Meeting. You can catch up on my daily reports that were published each day of the Annual Meeting, featuring the key science and innovations presented. And we'll have wrap-up episodes publishing in June, covering the full spectrum of malignancies from ASCO25. If you value the insights you hear on the ASCO Daily News Podcast, please remember to rate, review, and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   More on today's speakers: Dr. John Sweetenham   Dr. Erika Hamilton @erikahamilton9   Follow ASCO on social media:  @ASCO on Twitter  ASCO on Bluesky  ASCO on Facebook   ASCO on LinkedIn     Disclosures:     Dr. John Sweetenham:     No relationships to disclose    Dr. Erika Hamilton: Consulting or Advisory Role (Inst): Pfizer, Genentech/Roche, Lilly, Daiichi Sankyo, Mersana, AstraZeneca, Novartis, Ellipses Pharma, Olema Pharmaceuticals, Stemline Therapeutics, Tubulis, Verascity Science, Theratechnologies, Accutar Biotechnology, Entos, Fosun Pharma, Gilead Sciences, Jazz Pharmaceuticals, Medical Pharma Services, Hosun Pharma, Zentalis Pharmaceuticals, Jefferies, Tempus Labs, Arvinas, Circle Pharma, Janssen, Johnson and Johnson   Research Funding (Inst): AstraZeneca, Hutchison MediPharma, OncoMed, MedImmune, Stem CentRx, Genentech/Roche, Curis, Verastem, Zymeworks, Syndax, Lycera, Rgenix, Novartis, Millenium, TapImmune, Inc., Lilly, Pfizer, Lilly, Pfizer, Tesaro, Boehringer Ingelheim, H3 Biomedicine, Radius Health, Acerta Pharma, Macrogenics, Abbvie, Immunomedics, Fujifilm, eFFECTOR Therapeutics, Merus, Nucana, Regeneron, Leap Therapeutics, Taiho Pharmaceuticals, EMD Serono, Daiichi Sankyo, ArQule, Syros Pharmaceuticals, Clovis Oncology, CytomX Therapeutics, InventisBio, Deciphera, Sermonix Pharmaceuticals, Zenith Epigentics, Arvinas, Harpoon, Black Diamond, Orinove, Molecular Templates, Seattle Genetics, Compugen, GI Therapeutics, Karyopharm Therapeutics, Dana-Farber Cancer Hospital, Shattuck Labs, PharmaMar, Olema Pharmaceuticals, Immunogen, Plexxikon, Amgen, Akesobio Australia, ADC Therapeutics, AtlasMedx, Aravive, Ellipses Pharma, Incyte, MabSpace Biosciences, ORIC Pharmaceuticals, Pieris Pharmaceuticals, Pieris Pharmaceuticals, Pionyr, Repetoire Immune Medicines, Treadwell Therapeutics, Accutar Biotech, Artios, Bliss Biopharmaceutical, Cascadian Therapeutics, Dantari, Duality Biologics, Elucida Oncology, Infinity Pharmaceuticals, Relay Therapeutics, Tolmar, Torque, BeiGene, Context Therapeutics, K-Group Beta, Kind Pharmaceuticals, Loxo Oncology, Oncothyreon, Orum Therapeutics, Prelude Therapeutics, Profound Bio, Cullinan Oncology, Bristol-Myers Squib, Eisai, Fochon Pharmaceuticals, Gilead Sciences, Inspirna, Myriad Genetics, Silverback Therapeutics, Stemline Therapeutics

Thinking about becoming an insurance agent? In this episode, we weigh the pros and cons of selling insurance, so you'll have the information you need before you make that big decision!   Read the text version   Get Started by Registering with Ritter Insurance Marketing: https://app.ritterim.com/public/registration/   Learn More with These Resources: 2025 Maximum Broker Commissions for Medicare Advantage & Medicare Part D Update: https://lnk.to/dFX1s1 2025 State of the Senior Market Address: In Review: https://ritterim.com/blog/2025-state-of-the-senior-market-address-in-review/ 5 Perks of Being a Part-Time Insurance Agent: https://lnk.to/YGJ3KX Agent Survival Guide Podcast: https://lnk.to/asgpodcast Building Client Loyalty: More than Just a Plan: https://ritterim.com/blog/building-client-loyalty-more-than-just-a-plan/  Contact the Ritter Sales Team: https://ritterim.com/contact/ Four Reasons Why Ritter Should Be Your FMO Insurance Agency: https://ritterim.com/blog/four-reasons-why-ritter-should-be-your-fmo-insurance-agency/ Get Access to Exclusive Leads When You Become a PlanEnroll Network Agent: https://lnk.to/3pKJsF   How Insurance FMOs Work: https://ritterim.com/how-insurance-fmos-work/?utm_source=asg_podcast_link How Much Can Agents Make Selling Under-65 Insurance? https://lnk.to/TlGBGH How Much Can Insurance Agents Make Selling Medicare? https://ritterim.com/blog/how-much-can-insurance-agents-make-selling-medicare/ How Professional Organizations Make You a Better Agent: https://ritterim.com/blog/how-professional-organizations-make-you-a-better-agent/  REWIND: 8 Relationship Marketing Strategies for Insurance Agents: https://lnk.to/9b3cTl Ritter Insurance Marketing eBooks & Guides: https://ritterim.com/guides/ Ritter Insurance Marketing Events: https://ritterim.com/events/ The Advantages of Being a Field vs. Call Center Insurance Agent: https://ritterim.com/blog/the-advantages-of-being-a-field-vs-call-center-insurance-agent/  The Guide to Earning a Living Selling Health Insurance: https://ritterim.com/earning-a-living-selling-insurance/?utm_source=asg_podcast_link Your Step-By-Step Guide to Getting Started in Insurance Sales: https://ritterim.com/free-guide/?utm_source=asg_podcast_link   References: Cubanski, Juleette. “A Current Snapshot of the Medicare Part D Prescription Drug Benefit.” KFF.Org, KFF, 9 Oct. 2024, www.kff.org/medicare/issue-brief/a-current-snapshot-of-the-medicare-part-d-prescription-drug-benefit/. “Marketplace 2025 Open Enrollment Period Report: National Snapshot.” CMS.Gov, Centers for Medicare & Medicaid Services, 17 Jan. 2025, www.cms.gov/newsroom/fact-sheets/marketplace-2025-open-enrollment-period-report-national-snapshot-2. Rosanes, Mark. “Want to Build a Career Selling Insurance? Here Are the Pros and Cons.” Insurance Business America, Insurance Business, 22 Jan. 2024, www.insurancebusinessmag.com/us/guides/want-to-build-a-career-selling-insurance-here-are-the-pros-and-cons-473774.aspx.   Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://x.com/RitterIM and YouTube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel  Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/   Not affiliated with or endorsed by Medicare or any government agency. Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail.

Clinical denials by payers for sepsis continues. The problem: the definition of the enigmatic condition does not meet their propriety definitions.Enter Dr. James Kennedy, who will be the special guest during the next live edition of the long-running Monitor Mondays broadcast. Dr. Kennedy will report on his recent conversations with the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, in which the agency described its protocols in amending the Index and Table to fit new diseases and terminology.The venerable broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior healthcare government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Value is more than just a care model for Neil Reich. He recently joined Sarah to chat about his background in the Medicare Advantage space, his focus on value-based care, and how providing value still drives his business today.   Find Neil Reich Online: Care Connect Agency: https://careconnectagency.com/advisors/ Get the Playbook: https://careconnectadvisors.com/agent-playbook-download-form/ LinkedIn: https://www.linkedin.com/in/neil-reich-3382498   Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://x.com/RitterIM and YouTube, https://www.youtube.com/user/RitterInsurance       Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel    Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/    Not affiliated with or endorsed by Medicare or any government agency.  Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail. 

The Medicare Advantage Minute segment once again illustrates the fact that very few appeals were filed by MA victims of prior authorization refusals. However, the majority of those appeals resulted in reversals of the denials! In "Your Medicare Benefits 2025" we learn how Medicare covers insulin, including the newly created $35 monthly out-of-pocket limit! Moments before recording time a plea for assistance arrived from a victim of the barrage of MA plan brutality that happens to everyone who turns age 65. After hearing a radio interview he decided to emerge from hiding and take a chance on Medicare for the Lazy Man. Finally, How can one appeal a Part D lifetime late enrollment penalty? Just listen to find out! Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com.

"It was pretty apparent to me that something was going on with him," says Kristi Levine, describing the realization that, based on her experience as a Montessori teacher, her infant son, Trey, was missing developmental milestones. Unfortunately, Kristi's hunch turned out to be correct and Trey was later diagnosed with a rare genetic mutation called CACNA1A which is impacting his motor skills, balance, coordination and speech. Kristi and her husband, Eric, join host Michael Carrese on this installment in our Year of the Zebraseries to help us understand the disorder and its implications for Trey and their family, which includes Trey's older sister Stella.  “There's a lot of guilt involved in being a parent of a child who has a disability because you never feel like you're doing enough,” shares Eric, even though they both work full time and have becoming experts at juggling work, caregiving, advocating, and volunteering with the CACNA1A Foundation. In this candid interview, Eric and Kristi discuss the challenges of parenting a child with complex medical needs, the importance of community support, the ongoing search for treatment options, and share some advice for clinicians caring for patients and families living with rare disorders. “We just want medical professionals to respect and understand what we're dealing with on a day-to-day basis and to see our kids holistically, and not just try to fix the problem medically. Understand that for us, the biggest thing that we want for our kids is just their quality of life.”Mentioned in this episode:CACNA1A Foundation If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

In the Medicare Advantage Minute we (again) read that Dr. Oz plans to scrutinize Medicare Advantage plans to make sure they don't continue to pursue the underhanded tactics, like "upcoding" that have allowed some of them to loot the US Treasury for year after year. In "Your Medicare Benefits 2025" the topic of the day is Inpatient Rehabilitation Care. The rest of the episode consists of correspondence and questions from clients and soon-to-be clients. Just what the content curator ordered! Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com.

During this episode of the Industry Matters podcast, Ronda Buhrmester, Senior Director of Payer Relations and Reimbursement at VGM & Associates and Noel Neil, Chief Compliance Officer at ACU-Serve, delve into the complexities of lymphedema compression therapy as a DME benefit. They discuss essential compliance and documentation requirements, market analysis, recent HCPCS code updates, and the challenges and opportunities within the Medicare Advantage space. They also provide valuable insights on managing product categories, maintaining compliance, and the implications of billing upgrades. If you're considering adding lymphedema compression to your offerings or you already provide compression, this episode provides crucial information and actionable guidance to ensure you navigate this space successfully.Resources:https://cgsmedicare.com/jc/education/lymphedema_compression.htmlhttps://cgsmedicare.com/jc/pubs/news/2023/12/cope147943.htmlhttps://med.noridianmedicare.com/web/jddme/dmepos/lymphedema-compression-treatment

The nation's Medicaid program has seen better days. Recently, the federal government's program to provide healthcare coverage to America's low-income and vulnerable citizens was used as a bargaining chip as congressional Republicans were in the throes of budget negotiations, facing the daunting task to pass what President Trump calls his “big, beautiful bill:” a package of tax breaks disproportionately favoring the wealthy and spending cuts. The bill, which last week passed in the U.S. House of Representatives, is now making its way through the Senate.Then there was the announcement this midweek that the Deputy Administrator and Director of the Center for Medicaid and Children's Health Insurance Program (CHIP) Services, Drew Synder, was resigning from the federal agency.Reporting on these developing stories during the next live edition of the long-running Internet broadcast Monitor Mondays will be Drew Updike, MD.The venerable broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior healthcare government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

REPORTER'S NOTEBOOK WITH HOWARD CASTAY, OWNER OF KBZE 105.9FM:  June 4, 2025 Castay interviews Darren Grubb, a spokesman for the Medicare Advantage Majority, an organization dedicated to protecting and strengthening the Medicare Advantage program for 34 million American seniors and people with disabilities.  You can help with their advocacy by visiting the organization's website at www.medicareadvantagemajority.org, and email an easy letter (already written on a template) to your members of Congress, in support of the Medicare Advantage Majority's effort.

Some of the sickest Medicare Advantage patients ran into problems getting end-of-life care. Ultimately many patients switched to traditional Medicare, costing taxpayers billions, according to an investigation by the Wall Street Journal. This is one of many Medicare Advantage practices that is now under government scrutiny. Both Congress and Medicare agency head Dr. Mehmet Oz are pushing for reforms to curb tactics that can boost federal payments to private insurers. The Department of Justice is also investigating major private insurance companies UnitedHealth, Aetna, Elevance Health and Humana. Jessica Mendoza discusses the investigations with WSJ's Anna Wilde Mathews. Further Listening: -Medicare, Inc. Part 1: How Insurers Make Billions From Medicare  -A Life-or-Death Insurance Denial  Sign up for WSJ's free What's News newsletter. Learn more about your ad choices. Visit megaphone.fm/adchoices

Medicare Advantage was designed to save the government money. But a Wall Street Journal investigation found that private insurers used the program to generate extra payments through questionable diagnoses. The investigation uncovered instances of potentially deadly illnesses like AIDS, where patients received no follow-up care, as well as diagnoses that were medically impossible. This happened in part when insurers sent nurse practitioners into Medicare Advantage recipients' homes. Jessica Mendoza discusses the investigation with WSJ's Christopher Weaver as well as a nurse who participated in the program.  Further Listening: -A Life-or-Death Insurance Denial  -Even Doctors Are Frustrated With Health Insurance  Sign up for WSJ's free What's News newsletter.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Walmart is piloting a digital badge to help Medicare Advantage members identify "food-as-medicine" eligible items — a move blending AI, healthcare, and retail. As always, this segment is brought to you by our friends at the A&M Consumer and Retail Group, Simbe, Mirakl, Ocampo Capital, Infios, and Clear Demand — the companies helping retailers win smarter, faster. For the full episode head here: https://youtu.be/rJh3sY4_BsU #walmart #foodasmedicine #medicareadvantage #retailnews

CMS has issued a major announcement that's reshaping how Medicare Advantage plans approach risk adjustment audits. A new era of oversight is here. Defined by tighter timelines, expanded audit scope, and heightened expectations around data accuracy. Along with the announcement, a detailed compliance memo introduces new submission deadlines that demand immediate attention from health plans. This shift has wide-reaching implications for compliance strategy, resource allocation, and revenue protection.In this bonus episode, we unpack what's changed, why it matters, and what plans need to consider next. Listen now.About Our Guest: Amanda Proctor is the Director of Coding Quality and Risk Mitigation and has over 14 years' experience in Risk adjustment and holds multiple certifications in Coding, Auditing, and Compliance and is an AAPC Approved Instructor. She specializes in Risk Mitigation, RADV Audits, Coding Compliance and Education.

In this episode, Jakob Emerson, Associate News Director at Becker's Healthcare, joins Scott Becker to break down UnitedHealth's leadership shakeup and turnaround plan, as well as major CMS changes that will dramatically increase audits of Medicare Advantage plans.

If you would like to work with Christian on your Medicare Health Plan, we currently work with people in 45 states. Those are the states we currently are licensed in. Christian and Christian Brindle Insurance Services represents many of the top insurance companies in the Medicare industry. Contact us for more information:➡️Our Site: https://https://www.christianbrindleinsuranceservices.com/ ✅Call (801)-255-5340.

This is Zack Fuss. Today, we're tackling a giant in a controversial and incredibly complex industry, UnitedHealth Group. At its recent apex, UNH was a half-trillion-dollar market cap business, the 15th largest listed business in the United States. Today, that market cap sits at just $275 billion. The company generates an excess of $400 billion in sales annually and produces $40 billion in EBITDA as it touches every facet of the American healthcare system. To break down UnitedHealthcare, I'm joined by Stephanie Niven, a co-PM of the Global Sustainable Equity Strategy within the Sustainable Equity Team at Ninety One. Stephanie has been following the company since 2012 and she helps us to unravel this intricate business. We explore how UnitedHealthcare operates as a fully integrated healthcare system from its insurance arm to its high-margin health services business. We also dive into the concept of value-based care, the recent headwinds from Medicare Advantage scrutiny, and whether the market is mispricing this complex giant amidst regulatory noise and leadership changes. Please enjoy this breakdown of UnitedHealth Group. ⁠⁠Subscribe⁠⁠ to Colossus Review For the full show notes, transcript, and links to the best content to learn more, check out the episode page⁠ ⁠here⁠⁠. —- This episode is brought to you by Octus, formerly Reorg, is the essential credit intelligence and data provider for nearly 40,000 professionals across the world's leading buy side firms, investment banks, law firms and advisory firms. By surrounding unparalleled human expertise with embedded AI technology, data and workflow tools, Octus unlocks powerful truths that fuel decisive action in financial markets. Visit⁠⁠ octus.com⁠⁠ to learn how rigorously verified intelligence is delivered at speed to create a complete picture across the entire credit lifecycle. —- Business Breakdowns is a property of Colossus, LLC. For more episodes of Business Breakdowns, visit⁠⁠ joincolossus.com/episodes⁠⁠. Editing and post-production work for this episode was provided by The Podcast Consultant (⁠⁠https://thepodcastconsultant.com⁠⁠). Show Notes (00:00:00) Welcome to Business Breakdowns (00:04:51) Understanding the US Healthcare System (00:10:24) UnitedHealth Group's Origins and Evolution (00:13:41) UnitedHealth Group's Business Model (00:22:36) Optum: The Overlooked Powerhouse (00:29:24) Value-Based Care: A New Approach (00:34:51) Current State of US Healthcare System (00:36:49) Regulatory Scrutiny and Media Attention (00:37:27) Investor Concerns and Company Response (00:42:49) Structural vs. Cyclical Issues (00:48:42) UnitedHealth's Technological Edge (00:52:07) Political Risks and Regulatory Environment (00:57:16) Medicare Advantage: A Closer Look (01:02:02) Lessons from UnitedHealth's Strategy

1. Se le complica a la gobernadora el asunto del presupuesto. Senado investigará el descuadre del presupuesto por los fondes de la tarjeta de salud. 2. No está claro dónde están en el presupuesto propuesto los $$ prometidos a los municipios. 3. A vistas de confirmación el próximo lunes las 3 nominadas- La anuncia TRS 4. Gobernadora anuncia plan para reformar el proceso de permisos. 5. HUMANA se sale de Medicare Advantage y se va de Puerto Rico. 6. Martes de energía con Ramón Luis Nieves 7. Pretenden quitarle poderes y responsabilidades a LUMA y devolverle funciones y control financiero a la AEE. 8. Pablo José pide información de por qué se descartaron las barcazas para la generación de emergencia.See omnystudio.com/listener for privacy information.

In this week's Omni Talk Retail Fast Five, sponsored by the A&M Consumer and Retail Group, Simbe, Mirakl, Ocampo Capital, Infios, and ClearDemand, Chris and Anne discussed: - Walmart helping Medicare Advantage members identify items to buy with their OTC benefits - E.l.f.'s acquisition of Hailey Bieber's beauty brand for $1 Billion - Victoria's Secret's website shutdown last week Aldi's new digital work experience program for teens in the UK And closed with a debate over whether David's Bridal's new store concept Diamonds & Pearls will work There's all that, plus Eugene Amigud of Infios stopped by for 5 Insightful Minutes on how AI will impact order management system design, along with everything from dum-dums and Mountainhead to Sydney Sweeney's bath water. e sure to check out all our other podcasts from the past week here, too: https://omnitalk.blog/category/podcast/ P.P.S. Also be sure to check out our podcast rankings on Apple Podcasts and on Feedspot Music by hooksounds.com #RetailNews #RetailPodcast #Walmart #ELFBeauty #HaileyBieber #ShopTalkEurope #Cybersecurity #RetailTech #AIinRetail #OmniTalk #RetailFastFive #VictoriaSecret #DavidBridal #Aldi #SupplyChainAI #GenAI

In this timely roundtable, Lisa and Hemma sit down with Mary Inman and Liz Soltan, two powerhouse advocates in the whistleblower legal space, to unpack the DOJ's newly revised Corporate Whistleblower Awards (CWA) Pilot Program and its implications for the compliance community.  We also explore what makes whistleblowing work, how to support internal and external reporters, and why this moment may mark a turning point for global whistleblower engagement. Highlights: Mary and Liz break down the newly added DOJ priority areas How the CWA Pilot Program could evolve into a DOJ equivalent of the SEC whistleblower program Why organizational justice and psychological safety must be embedded into internal reporting systems. How tips must result in asset forfeiture to trigger awards Why we need a speak-up culture, not just a hotline Resources  DOJ's May 2025 Criminal Division White-Collar Enforcement Plan Revised DOJ Corporate Whistleblower Awards Pilot Program: DOJ Announcement Speech by Matthew R. Galeotti at the SIFMA AML and Financial Crimes Conference Link to speech Whistleblowing Study by Stephen Stubbens and Kyle Welch Whistleblower Partners LLP: Mary Inman, Liz Soltan Biographies   Mary Inman Partner, Whistleblower Partners LLP Mary Inman is a seasoned attorney with over 30 years of experience representing whistleblowers under various U.S. programs, including the False Claims Act, SEC, CFTC, IRS, FinCEN, and NHTSA/DOT. After spending three years in London, she now focuses on international whistleblowers exposing misconduct with ties to the U.S.. She assists clients in bringing claims to foreign regulators such as the Ontario Securities Commission and the Canada Revenue Agency. Mary is renowned for her expertise in healthcare, tech, and financial services fraud. She has represented high-profile whistleblowers like Frances Haugen (Facebook) and Tyler Shultz (Theranos), and co-authored The Tech Workers' Handbook, a guide for tech industry whistleblowers. Her advocacy extends to testifying before global governmental bodies, including the European Commission and UK Parliament, championing the effectiveness of U.S. whistleblower programs. Mary holds a J.D. from the University of Pennsylvania Law School and has clerked for judges in both the U.S. District Court and the U.S. Court of Appeals. Outside of her legal work, she enjoys participating in her husband's YouTube channel and spending time in northern Maine. Liz Soltan Associate, Whistleblower Partners LLP Liz Soltan is an associate at Whistleblower Partners LLP, focusing on cases involving financial fraud, anti-money laundering, and sanctions evasion. Her notable work includes representing a foreign whistleblower in a FinCEN sanctions violation case concerning illegal sales to Russia. Liz also contributed to the landmark Medicare Advantage risk adjustment fraud case, United States ex rel. Poehling v. UnitedHealth Group, Inc. Before joining Whistleblower Partners, Liz served as a Skadden Fellow at Community Legal Services of Philadelphia, where she was part of a team that secured $712 million in emergency food stamp benefits for 650,000 households during the COVID-19 pandemic. She earned her J.D. cum laude from Harvard Law School, where she led the Wage and Hour Practice Group at the Harvard Legal Aid Bureau and successfully argued a workers' rights case before Massachusetts' highest court. Liz completed her undergraduate studies at Cornell University, graduating summa cum laude with a major in History and a minor in Spanish. Residing in Brooklyn, Liz maintains strong ties to her Philadelphia roots. She enjoys participating in a fiction-only book club, exploring historical sites, and spending time with her husband, son, and their two cats, Alex Trebek and Vanna White.

  Wondering what the difference between Medicare and Medicaid is? Learn all about it in this episode!   Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail.   Resources: 4 Effective Techniques for Closing Insurance Sales: https://lnk.to/asg655 2025 Maximum Broker Commissions for Medicare Advantage & Medicare Part D: https://ritterim.com/blog/2025-maximum-broker-commissions-for-medicare-advantage-and-medicare-part-d/ FREE DOWNLOAD – The Guide to Earning a Living Selling Health Insurance: https://ritterim.com/earning-a-living-selling-insurance/ How Much Can Agents Make Selling Under-65 Insurance? https://lnk.to/TlGBGH Leveling Up: From Chill Mode to Growth Mode ft. Christian Brindle: https://lnk.to/brindle2025 Ritter Insurance Marketing: https://ritterim.com/    References: Alice Burns, Elizabeth Hinton. “10 Things to Know about Medicaid.” KFF, 10 Apr. 2025, https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid/. Nall, Rachel. “Am I Eligible for Medicare Part D?” Medicalnewstoday.com, Medical News Today, 21 Apr. 2020, https://www.medicalnewstoday.com/articles/am-i-eligible-for-medicare-part-d. “Compare Original Medicare & Medicare Advantage.” Medicare.Gov, https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage. Accessed 15 May 2025. (DCD), Digital Communications Division. “What's the Difference between Medicare and Medicaid?” HHS.Gov, U.S. Department of Health and Human Services, 7 Dec. 2022, https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html. “Does Medicaid Cover Dental Care?” HHS.Gov, U.S. Department of Health and Human Services, 8 Dec. 2022, https://www.hhs.gov/answers/medicare-and-medicaid/does-medicaid-cover-dental-care/index.html. “Medicare Adult Dental Benefits Coverage by State.” Chcs.org, Center for Health Care Strategies, Inc., Sept. 2019, https://www.chcs.org/media/Medicaid-Adult-Dental-Benefits-Overview-Appendix_091519.pdf “What's the Difference between Medicare Part a and Part B?” Healthline, 25 Feb. 2020, https://www.healthline.com/health/medicare/medicare-part-a-vs-b. ‌”Understanding Medicare Advantage Plans.” Medicare.gov, Feb. 2025, https://www.medicare.gov/publications/12026-understanding-medicare-advantage-plans.pdf   Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://x.com/RitterIM and YouTube, https://www.youtube.com/user/RitterInsurance     Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel  Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/   Not affiliated with or endorsed by Medicare or any government agency.

Lee Camp digs into the new US/ Palantir partnership to track everyone. Plus the new ceasefire plan. PLUS the new plan to go after Russia. PLUS much more.To learn more about Chapter Medicare Advice, call 757-349-8232 or go to AskChapter.org/Camp *Chapter: Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory, LLC represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 50 organizations which offer 18,160 products nationwide. We search and recommend all plans, even those we don't directly offer. You can contact a licensed Chapter agent to find out the number of products available in your specific area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your option.*Average potential savings are based on realized premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors.

In this installment of Market Talk, Co-Founder and CXO Natalie Picha talks to Brian Hickey, Vice President of Medicare Back Office, a team of dedicated, licensed insurance agents providing nationwide Medicare advice. Their discussion includes: • The differences between Part A and Part B, and how to decide if you need a Medicare Supplement plan• What is Medicare Advantage, and what does the county I live in have to do with anything? • The importance of annual reviews of your Medicare benefits• When you should start exploring your optionsExperience the difference of working with a firm that empowers your life—a firm that focuses on what matters most—you. Whether you are beginning your financial journey now or have already taken steps toward your ultimate life goals, we are here to guide you. https://podcasts.apple.com/us/podcast/rhp-market-talk/id1538051530

Proven Strategies for Insurance Agents: Know Your Numbers and Boost SuccessIn this episode of 'The Agent Boost Podcast', Dan and Mike Hardle dive into vital strategies for insurance agents to track and manage their commissions effectively. They highlight the importance of knowing your numbers, tracking your revenue meticulously, and reinvesting in your business for sustainable growth. You'll also get insights into upcoming industry changes, the significance of certification season, and the secrets behind the success of their elite agent training programs. Whether you're a new agent or an experienced agency owner, this episode is packed with actionable advice to help you thrive in the insurance industry.Need to take your AHIP certification to sell Medicare Advantage plans? Use our official Agent Boost link to get started today. It's accepted by all major carriers and includes the $50 discount—bringing your cost down to just $125.

https://www.kff.org/medicare/issue-brief/key-facts-about-medigap-enrollment-and-premiums-for-medicare-beneficiaries/ If you would like to work with Christian on your Medicare Health Plan, we currently work with people in 45 states. Those are the states we currently are licensed in. Christian and Christian Brindle Insurance Services represents many of the top insurance companies in the Medicare industry. Contact us for more information:➡️Our Site: https://https://www.christianbrindleinsuranceservices.com/ ✅Call (801)-255-5340.

Welcome to Omni Talk's Retail Daily Minute, sponsored by Mirakl. In today's Retail Daily Minute:Costco beats Q3 expectations with an 8% sales jump and nearly 16% e-commerce growth, while holding prices on essentials and rerouting supply chains to reduce tariff exposure.Walmart rolls out new Medicare Advantage tools, including a virtual badge system and AI-driven nutrition insights, aiming to unlock billions in unused OTC benefits and expand its role in healthcare retail.Gap braces for up to $300M in added tariff costs, but holds the line on pricing—at least for now—as it continues a turnaround strategy focused on full-price sales, cost savings, and digital growth.The Retail Daily Minute has been rocketing up the Feedspot charts, so stay informed with Omni Talk's Retail Daily Minute, your source for the latest and most important retail insights. Be careful out there!

During the next edition of Monitor Mondays, famed whistleblower attorney Mary Inman, partner at Whistleblower Law, will provide an update on a whistleblower case that some consider “beyond bad.”You'll learn why a Texas rheumatologist who was sentenced to 10 years in prison and three years of supervised release was ordered to forfeit more than $28 million, plus 13 real-estate properties, a jet, and a Maserati GranTurismo sports car.Inman, long considered one of the nation's foremost whistleblower attorneys, will be the program's special guest during the next live edition of the venerable Internet broadcast, coming up at 10 a.m. EST on Monday, June 2, 2025.The long-running broadcast will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.Field Report: Drew Updike will continue his reporting on efforts by the Trump Administration to intervene in healthcare issues – namely the Centers for Medicare & Medicaid Services (CMS) Form 64 related to migrants and Medicaid.

In this episode, Mary N. Mannix, President and CEO of Augusta Health, shares insights on navigating Medicaid and Medicare Advantage challenges, the importance of innovation in healthcare, and Augusta Health's investment in workforce development through its new graduate medical education program. She also discusses the organization's commitment to community health and the power of leading with optimism.

JCO Editorial Fellow Dr. Lauren Shih and JCO Associate Editor Dr. Stephanie Wheeler discuss the ASCO 25 Simultaneous Publication paper "Use of Low-Value Cancer Treatments in Medicare Advantage Versus Traditional Medicare." Transcript The guest on this podcast episode has no disclosures to declare. Dr. Lauren Shih: Hello, and welcome to our 2025 ASCO annual meeting series where we cover some of the top JCO papers published simultaneously with their abstract presentations at this year's meeting. I'm your host, Dr. Lauren Shih, JCO editorial fellow, and I'm joined by JCO Associate Editor Dr. Stephanie Wheeler to discuss the Journal of Clinical Oncology article and abstract presentation "Use of Low-Value Cancer Treatments in Medicare Advantage Versus Traditional Medicare." Let's start with the relevance of the article. Dr. Wheeler, can you explain this to our listeners? Dr. Stephanie Wheeler: Thank you so much. Let's get right into it. So this article is really about understanding different types of Medicare plans and what we should expect to see in terms of their use of low-value treatments for cancer patients. So, as Medicare really is focused on trying to limit the use of low-value cancer treatments, we really need to better understand the drivers of variability. So we know that many cancer patients have multiple treatment options available to them. We also know that the vast majority of older adults beyond age 65 are insured by Medicare, and about half of them are on Medicare Advantage plans, which are serviced by private insurance. And private insurance companies in this case are receiving capitated payments for Medicare beneficiaries to manage their service utilization and reduce costs. So, with respect to Medicare Advantage versus the traditional fee-for-service Medicare, it's not really been known to what extent low-value treatments are differentially used by these types of plans for cancer patients. And so that was really the focus of this article. What the authors found is that across six different types of treatments, in general, the folks who were enrolled in Medicare Advantage plans had reduced use of low-value treatment. So that's a good sign for Medicare beneficiaries. And although the relative difference in that use was somewhat low, this translates to a significant number of Medicare enrollees across the country not receiving these low-value treatments. And of course, this translates to considerable savings at the society level. Dr. Lauren Shih: Are there any additional key results that we should review? Dr. Stephanie Wheeler: Yeah. So I'll tell you just a little bit more about the methods and also their findings. So they looked at six different low-value treatments, and this was in, again, 100% of national Medicare enrollees from 2015 through 2021. So the six low-value treatments that they examined were the use of G-CSFs among patients receiving low-risk chemotherapy and denosumab for those who had castration-sensitive prostate cancer. Then they also looked at four high-cost treatments, including using nab-paclitaxel instead of paclitaxel for patients with breast or lung cancer; second, adding bevacizumab to carboplatin plus paclitaxel for ovarian cancer; third, using brand-name drugs instead of generics when generics were available; and fourth, using biologics instead of biosimilars when biosimilars were available. And these are all, by the way, non-recommended treatments according to a variety of guidelines, including NCCN and ASCO's Choosing Wisely guidelines. So they used the Medicare claims data to examine use of these regimens. They also analyzed results by type of Medicare Advantage plan, whether people were enrolled in a health maintenance organization plan, or an HMO, or a preferred provider organization plan, or a PPO. They also looked at the largest Medicare Advantage insurers—including Aetna, Blue Cross Blue Shield, Cigna, Humana, and UnitedHealth—and limited their analyses to those that had complete encounter data. And what they found across the board is that the enrollees in Medicare Advantage plans generally had lower use of these low-value treatments. And the largest differences between Medicare Advantage and traditional Medicare plans were in the outcomes, including G-CSF use and using denosumab for castration-resistant prostate cancer, and then the combination of bevacizumab, carboplatin, and paclitaxel versus carboplatin and paclitaxel. And all of these had a change in use ranging from about 19% change to 24% change in use. This is significant as a field as we look at ways in which different plan organization can influence use of treatments, particularly given the excess cost of cancer care. This is something we really want to pay attention to. So I'd encourage folks to look more closely at the results by treatment type as well as the results by plan type to see a little bit more about what was going on across different plan types. Dr. Lauren Shih: Great. And are there any outstanding questions that need to be answered? Dr. Stephanie Wheeler: Yes, there always are, of course. I think the study has several strengths that are worth noting. First, they have 100% of Medicare enrollees, so there's national coverage there, which is, you know, quite outstanding. They also use an appropriate choice of analysis to help deal with some of the selection. So they use inverse probability of treatment weights, and they control for practice and county indicators to try to get some realistic adjustment for the selection that happens in terms of how patients are enrolled in different Medicare Advantage versus traditional fee-for-Medicare plans. These statistical approaches are a good idea, but they are limited by the observed variables that we can use for these kinds of adjustments. And so any unobserved—confounding or any unobserved factors that would influence selection in these plans aren't going to be captured well. So preferences, for example, that patients may have about different types of plans when they're insuring themselves and their families may not be captured. Second, the data that are used are only encounter data from those plans with complete records. That may mean that smaller Medicare Advantage insurers or those that don't have as comprehensive records are not included. So this may not be reflective of their practice patterns. And then third, of course, this only looked at six different low-value cancer treatments. It remains to be seen whether this kind of finding extends to other types of low-value cancer treatments, and that's an opportunity for future study. Finally, I would say that we don't exactly know why these patterns exist. It could be that Medicare Advantage plans have different approaches to prior authorization. They could have more in-house quality control and management to really understand, among their population for whom they're receiving Medicare Advantage payments, to really look at care quality and assess Choosing Wisely guidelines. We don't know exactly how that's playing out. And so we need additional data to really figure out what's working here and what are opportunities for future policy and payment innovations that can further reduce low-value care. Dr. Lauren Shih: Great. Thank you so much, Dr. Wheeler, for speaking to us about the JCO article, "Use of Low-Value Cancer Treatments in Medicare Advantage Versus Traditional Medicare." We really appreciate your insights. Dr. Stephanie Wheeler: Thanks for having me. Dr. Lauren Shih: Join us again for the latest simultaneous publications from the ASCO 2025 Annual Meeting. Please take a moment to rate, review, and subscribe to all ASCO podcast shows at asco.org/podcasts. Until then, enjoy the rest of ASCO 2025. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

In the "Medicare Advantage Minute" we go through news article reporting that the majority of MA members are confused. It had some other negatives to report about Medicare Advantage as well In "Your Medicare Benefits 2024 (or maybe 2025)" we learn exactly how Medicare covers in-home hospice care. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com.

Lee Camp digs into the recent Venezuelan elections, 10 horrible things hidden inside Trump's "beautiful" bill, and moreTo learn more about Chapter Medicare Advice, call 757-349-8232 or go to AskChapter.org/Camp *Chapter: Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory, LLC represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 50 organizations which offer 18,160 products nationwide. We search and recommend all plans, even those we don't directly offer. You can contact a licensed Chapter agent to find out the number of products available in your specific area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your option.*Average potential savings are based on realized premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors.

We have a special guest on today's episode whose voice will be familiar to regular listeners. Last year at this time, Dr. Raven Baxter occupied the Raise the Line host chair for a special ten-part series we produced in collaboration with the Cohen Center for Recovery from Complex Chronic Illness (CoRe) at Mount Sinai in New York City, where she serves as the Director of Science Communication. The series explored the latest understandings of post-acute infection syndromes -- such as Chronic Lyme and Long COVID -- with an array of experts from the Center and other researchers and providers. In this episode, we check-in with Dr. Baxter to get an update on the work of the Cohen Center, especially with regard to its mission to educate providers. “We're building programs so that clinicians can earn credit for learning about chronic illnesses that are infection associated, and we've also developed a 200-page provider manual. I really think that we will be able to shift the narrative that currently exists,” Dr. Baxter tells host Michael Carrese. That narrative includes lingering skepticism among providers of some infection-associated illnesses, which Dr. Baxter witnessed herself as a Long COVID patient, an experience that has added meaningful perspective to her work. Dr. Baxter is also working on her own time to advance knowledge and combat misinformation through a robust social media presence as “The Science Maven” and helps other scientists and clinicians to do the same. "If we're not there to fill in that void, other people will fill it for us and the narrative may not be consistent with the truth or facts." This is a great opportunity to learn about the art and science of communications that can reach clinicians and patients alike.Mentioned in this episode:Cohen Center for Recovery from Complex Chronic IllnessThe Science Maven If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

The former Israeli Prime Minister Ehud Olmert has accused Israel of war crimes. Plus the US and Germany have decided to remove all range restrictions for Ukraine.To learn more about Chapter Medicare Advice, call 757-349-8232 or go to AskChapter.org/Camp *Chapter: Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory, LLC represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 50 organizations which offer 18,160 products nationwide. We search and recommend all plans, even those we don't directly offer. You can contact a licensed Chapter agent to find out the number of products available in your specific area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your option.*Average potential savings are based on realized premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors.

Are hospitals locking out Medicare Advantage enrollees? Find out the likely real reason behind the shutout and why we should be worried if MA can no longer compete with traditional fee-for-service Medicare. Join AnneMarie Schieber, managing editor of Health Care News, and Devon Herrick of the Goodman Institute Health Blog as they discuss the latest headlines in health care from a free-market perspective. Also on their radar: the mad rush by states to pass assisted medical suicide bills. Is the U.S. becoming Canada? Is assisted suicide becoming a means to ration ever-escalating health care costs?Additionally, former President Joe Biden's aggressive prostate cancer is receiving increasing attention as Congress probes who knew what—and when—about Biden's cognitive impairment. How in the world could a president not be screened regularly for a condition he previously had? Finally, will it be the carrot or the stick when it comes to creating rules based on the MAHA Commission report? In The Tank broadcasts LIVE every Thursday at 12pm CT on on The Heartland Institute YouTube channel. Tune in to have your comments addressed live by the In The Tank Crew. Be sure to subscribe and never miss an episode. See you there!Climate Change Roundtable is LIVE every Friday at 12pm CT on The Heartland Institute YouTube channel. Have a topic you want addressed? Join the live show and leave a comment for our panelists and we'll cover it during the live show!

Trump's lies are not words; they have deadly and costly effects producing calamitous consequences. AOC scolds Republicans for supporting the for-profit Medicare Advantage waste fraud and abuse.Subscribe to our Newsletter:https://politicsdoneright.com/newsletterPurchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make AmericaUtopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And BeFit Now: https://amzn.to/3xiQK3K Tribulations of anAfro-Latino Caribbean man: https://amzn.to/4c09rbE

Patients with Medicare Advantage insurance coverage: rural hospitals are asking themselves whether they can afford to keep accepting them! This is the subject of our "Medicare Advantage Minute" today. In "Your Medicare Benefits 2025" we learn how Medicare would cover home infusion therapy services. Then we spot check some rate increase statistics in order to determine whether inflationary trends are still exerting upward pressure on insurance premiums. They are. Medicare is not allowed to provide and pay for drugs whose only function is weight loss. Some of the newly distributed GLP-1 drugs provide weight loss effects as well as beneficial treatment of heart disease and type 2 diabetes. This causes a high demand for these expensive meds. Finally, we learn what some pinko organization thinks are the best states and worst states for overall health care access. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com.

In this episode of Bright Spots in Healthcare, host Eric Glazer explores how leading healthcare organizations are transforming specialty care in Medicare Advantage through physician leadership and AI innovation. Hear from Julia McDowell (Highmark Health), Chuck Palermo (HAP), Dr. Mary O'Connor (Vori Health), and Dr. Krystal Revai (Health Alliance) as they share pragmatic strategies for improving care quality, enhancing member engagement, reducing administrative burden, and delivering meaningful clinical outcomes. Discover how AI is being used to streamline prior authorization, enable real-time gap closure, personalize care management, and deepen shared decision-making between providers and patients.   Thank you to Vori Health for supporting this episode.  Vori Health is the only nationwide MSK medical practice with doctor-led care teams – driving better outcomes. Vori helps with pain reduction in MSK issues, through their holistic approach, and by creating a personalized treatment plan from the convenience of your own home through their  virtual-first platform.  Their doctor-led team tailors care programs to reduce surgery by as much as 78%, avoiding pain, imaging, and injections and saving your organization the cost burden of unnecessary surgeries and increasing productivity. And all from the comfort of home!  Vori is on a mission to empower humanity to lead a healthier life. Visit them at www.vorihealth.com/

Join us at the Seven Figure Medicare Agent Summit: https://sevenfiguremedicareagentsummit.com/On this episode of the Seven Figures or Bust podcast, we address the growing trend of non-commissionable Medicare plans and what it means for agents. With major carriers like Aetna, Cigna, and Elevance Health shifting certain Medicare Advantage and Part D plans to non-commissionable status for 2025, agents face new challenges in maintaining their income streams . We delve into strategies for navigating these changes, including diversifying your product offerings and ensuring compliance with CMS guidelines when discussing non-commissionable plansGets Leads from Lead heroes here: https://leadheroes.com/Learn more about getting your own VA with Hire Heroes here: https://app.hireheroes.com/signup?fpr=christian43Join our free private Facebook group for insurance agents: https://www.facebook.com/groups/551409828919739/Welcome to the Christian Brindle channel brought to you by Christian Brindle & Christian Brindle Insurance Services. This channel is here for the sole purpose of bringing training, tips, success stories, and personal development from Christian Brindle. Christian is a published author, hosts the ever popular Everything Medicare Podcast, and made six figures in the Medicare business by the time he was 25 years old.

* AOC scolds Republicans for supporting the for-profit Medicare Advantage waste, fraud, and abuse: Alexandria Ocasio-Cortez explains the Medicare Advantage waste, fraud, and abuse, and challenges Republicans to support an amendment to take back the stolen money to enhance Americans' healthcare. [More]* When Trump Lies, Democracy Dies: Trump's lies are no lo… To hear more, visit egberto.substack.com

Alexandria Ocasio-Cortez explains the Medicare Advantage waste, fraud, and abuse, and challenges Republicans to support an amendment to take back the stolen money to enhance Americans' healthcare.Subscribe to our Newsletter:https://politicsdoneright.com/newsletterPurchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make AmericaUtopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And BeFit Now: https://amzn.to/3xiQK3K Tribulations of anAfro-Latino Caribbean man: https://amzn.to/4c09rbE

AOC scolds Republicans for supporting the for-profit Medicare Advantage waste, fraud, and abuse. CNN's Jake Tapper allows the Speaker to spin. This is a five-alarm fire.Subscribe to our Newsletter:https://politicsdoneright.com/newsletterPurchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make AmericaUtopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And BeFit Now: https://amzn.to/3xiQK3K Tribulations of anAfro-Latino Caribbean man: https://amzn.to/4c09rbE

Lee Camp and Eleanor Goldfield cover Trump's new massive giveaway to the rich, cuts for the poor. Plus, Israel sh---ing at diplomats, and much more!To get FREE help navigating Medicare and Medicare Advantage, call 757-349-8232 or go to AskChapter.org/Camp *Chapter: Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory, LLC represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 50 organizations which offer 18,160 products nationwide. We search and recommend all plans, even those we don't directly offer. You can contact a licensed Chapter agent to find out the number of products available in your specific area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your option. *Average potential savings are based on realized premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors.

This podcast is brought to you by Outcomes Rocket, your exclusive healthcare marketing agency. Learn how to accelerate your growth by going to outcomesrocket.com What if the key to transforming healthcare isn't just technology, but bringing compassionate, personalized care back into the home? In this episode, Dr. Jessica Son, Chief Medical Officer of Clover Care Services at Clover Health, shared her journey from primary care physician to healthcare executive, driven by a desire to fix systemic gaps she observed while doing house-call medicine. At Clover Health, a next-generation Medicare Advantage company, she leads value-based care initiatives that combine technology with human-centered delivery. Their AI-powered Clover Assistant equips physicians with real-time insights to improve outcomes and reduce care gaps, while an in-home clinical team ensures patients receive personalized and coordinated support. Dr. Son emphasized the urgency of proactive, compassionate care amid a strained healthcare system and a growing elderly population. She welcomes partnerships with organizations and providers who share Clover's mission to improve lives through holistic, home-based care. Tune in for a powerful conversation on how Clover Health is blending technology, human connection, and home-based support to improve outcomes for those who need it most! Resources: Connect with and follow Dr. Jessica Son on LinkedIn. Follow Clover Health on LinkedIn and explore their website.

Lee Camp digs into Trump's admission that 300,000 Gazans have been killed, DOGE may be coming to an end, a social media star is mocked for speaking to the police, Biden has cancer, and Trump is working to crush the ICC. All that and more!To learn more about Chapter Medicare Advice, call 757-349-8232 or go to AskChapter.org/Camp *Chapter: Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory, LLC represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 50 organizations which offer 18,160 products nationwide. We search and recommend all plans, even those we don't directly offer. You can contact a licensed Chapter agent to find out the number of products available in your specific area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your option.*Average potential savings are based on realized premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors.

The $84 billion question haunting American healthcare takes center stage as Nathan Kaufman returns to unpack the bombshell criminal investigation into UnitedHealthcare's alleged Medicare fraud. Drawing from his 48 years of healthcare expertise, Kaufman reveals the troubling mechanics behind how the nation's largest insurer potentially manipulated the Medicare Advantage system through aggressive "upcoding" – artificially inflating patient illness scores to extract higher government payments.This eye-opening conversation exposes the stark reality that UnitedHealthcare somehow generated a staggering 95% of all Medicare Advantage profits in 2024, raising serious questions about their operational practices compared to competitors. We dive deep into the company's concerning denial patterns, where approximately one in ten Medicare Advantage claims gets rejected, yet when patients fight back, 70-80% of appeals succeed – suggesting many initial denials lack merit.Beyond the investigation itself, we explore the fundamental conflict at the heart of our healthcare system: the misaligned incentives that reward denying care rather than providing it. As Kaufman aptly describes healthcare as "the largest segment of the largest economy in the history of the world," we confront the uncomfortable truth that 24 cents of every federal dollar now flows into a system that too often prioritizes corporate profits over patient wellbeing. Whether you're concerned about healthcare costs, insurance practices, or the future of Medicare and Medicaid, this conversation offers crucial insights into how the complexity and opacity of our healthcare system benefits powerful interests while leaving patients vulnerable. Subscribe now to join our growing community of listeners seeking fiercely nonpartisan analysis of today's most pressing issues.Support the showEngage the conversation on Substack at The Common Bridge!

In this episode, Scott Becker discusses the mounting challenges facing UnitedHealthcare, including a DOJ investigation into Medicare Advantage fraud, the abrupt resignation of CEO Andrew Whitty, and a steep stock decline shaking investor confidence.

Today's Headlines: President Trump kicked off his Middle East trip in Saudi Arabia, meeting with Crown Prince Mohammed bin Salman and announcing the removal of sanctions on Syria, citing MBS's request. Trump also revealed a $600 billion Saudi investment in the US and a $142 billion arms deal, while suggesting Iran should negotiate its nuclear program. Meanwhile, Senate Minority Leader Chuck Schumer is blocking DOJ nominees over concerns about Trump's acceptance of a luxury jet from Qatar. In domestic news, the Department of Homeland Security has terminated Temporary Protected Status for 9,000 Afghans, clearing the way for deportation. April's inflation report showed positive signs, with a 0.2% rise in CPI and the annual rate dropping to 2.3%. UnitedHealthcare's CEO resigned following a class-action lawsuit and financial fallout related to Medicare Advantage overcharges. Lastly, P Diddy's sex trafficking trial began, with his ex Cassie Ventura testifying about years of abuse and exploitation, alleging that her music career was sidelined for Diddy's personal demands. Resources/Articles mentioned in this episode: WA Post: Trump says U.S. will end sanctions on Syria ‘to give them a chance at greatness'  NBC News: Chuck Schumer says he is placing a hold on Trump DOJ nominees amid questions on Qatar's luxury jet gift Politico: DHS terminates temporary protected status program for Afghans  CNBC: Annual inflation rate hit 2.3% in April, less than expected and lowest since 2021  WSJ: UnitedHealth CEO Is Out, Sending Shares Plummeting NBC News: Cassie testifies at Diddy's sex trafficking trial of abuse and humiliation from 'freak offs' Morning Announcements is produced by Sami Sage and edited by Grace Hernandez-Johnson Learn more about your ad choices. Visit megaphone.fm/adchoices

Lee Camp gets into the Liberal media going nuts over Pentagon firings AND RFK Jr. outing Trump and his $100 Million from Big Pharma PLUS the truth about Zelensky! To get FREE help navigating Medicare and Medicare Advantage, call 757-349-8232 or go to AskChapter.org/Camp *Chapter: Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory, LLC represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 50 organizations which offer 18,160 products nationwide. We search and recommend all plans, even those we don't directly offer. You can contact a licensed Chapter agent to find out the number of products available in your specific area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your option. *Average potential savings are based on realized premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors.