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Israel and Iran pull back from the brink

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Israel and Iran pull back from the brink

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Almost immediately after blasts erupted over an air base near Isfahan in the early hours of Friday, Iran did its utmost to play down Israel’s retaliatory attack against the Islamic republic.

Iranian commanders said there was no damage and that the explosions were caused by air defence batteries taking out unidentified objects. There were no accusations thrown at Israel or calls for revenge.

President Ebrahim Raisi made no mention of the attack when he gave a live televised speech hours later, even though officials have previously vowed to retaliate immediately to any direct Israeli assault on Iranian territory.

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In Israel, there was a similarly muted response. Ever since Iran launched its first direct assault on Israel from Iranian soil last week, there was never any doubt that Benjamin Netanyahu’s government would respond. The only question was when and on what scale.

But when the response came it appeared — so far — to be limited. And Israel neither confirmed nor denied the attack, choosing not to take ownership as Israelis went about their normal daily business.

A man watches Iranian television coverage of the explosions in central Isfahan province on Friday © Fatemeh Bahrami/Anadolu/Getty Images

For the moment, it appears the arch foes — which have been gambling with the stability of the Middle East as they upped the ante in their long-simmering conflict — have pulled back from the brink.

Netanyahu, known to be risk-averse despite his belligerent rhetoric, seems to have heeded the advice of the US and Israel’s other western allies rather than his far-right allies who called for a “crushing” counterstrike. The measured, targeted response to Iran’s attack for now eases the risk of sparking a full-blown regional war.

Last weekend’s Iranian assault, though huge in terms of the projectiles launched, was telegraphed well in advance and also caused minimal damage. Tehran, which mounted that attack in response to an Israeli strike on its consulate in Damascus this month, also made clear it was “mission accomplished” and that it did not want a further escalation.

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But even if the region, which has been on tenterhooks for days, breathes a sigh of relief, it will be only momentary.

Since Hamas’s brutal attack on October 7 and Israel’s ferocious retaliatory offensive in Gaza, the Middle East has been on a dangerous escalatory spiral.

Hostilities have erupted on multiple fronts between Israel and Iranian-backed militants. US troops have been drawn into combat in Iraq, Syria and Yemen. Israel and Hizbollah, the Iranian-backed Lebanese militant movement, have been locked in daily cross-border combat that at any other time would be considered all-out war.

Pre-existing red lines between Israel, Iran and its proxies have been blurred while old precedents have gone by the wayside.

Iran’s supreme leader Ayatollah Ali Khamenei
Iran’s supreme leader Ayatollah Ali Khamenei took a huge gamble by launching a direct strike on Israel © Iranian Supreme leader’s Office/dpa

Iran’s direct strike on Israel was a huge gamble by Ayatollah Ali Khamenei, the supreme leader. He put aside, at least temporarily, his long-held strategy of “strategic patience” to underline that he was willing to risk his top priority — the survival of the republic — and direct conflict if he felt Israel crossed a line.

By striking Iran’s diplomatic mission in Damascus, Israel had also pushed Tehran too far, crossing a critical line for the regime. For Netanyahu, the strike was a signal that no target was off limits as Israel seeks to restore its deterrence after the huge intelligence failure it suffered on October 7.

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The overnight attack on Friday bore the hallmarks of Israel’s more traditional approach to hitting Iranian assets through calibrated targeted strikes and assassinations. But it is far too early to assume the long-simmering Israeli-Iranian conflict has gone back into the shadows.

Israel can be expected to continue to target Iranian assets, particularly in Syria where it has already killed at least 18 Revolutionary Guards members, including senior commanders, since October. Israeli jets reportedly struck military targets in Syria as it mounted Friday’s attack on Iran.

Even if both sides — as they claim — want to avoid a full-blown war, another miscalculation or provocation could light the fuse for the next escalation. The volatile situation is made all the more precarious because the rules are constantly changing and the stakes are increasing: what one side deems a calculated action, the other might consider an unacceptable provocation.

Both are also determined to show that their respective deterrents are being restored and both face pressures from domestic constituencies to respond to the others’ hostility.

This is the grim reality that has been in existence since Hamas’s attack killed 1,200 people, according to Israeli officials. And the longer Israel’s offensive in Gaza continues, adding to a death toll that Palestinian officials say has reached almost 34,000 people, the greater the risks will be.

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All-out war may have been averted for now, but the danger for the Middle East and beyond has far from passed.

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Trump sues IRS and Treasury for $10 billion over leaked tax information

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Trump sues IRS and Treasury for  billion over leaked tax information

The Internal Revenue Service building May 4, 2021, in Washington.

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WASHINGTON — President Donald Trump is suing the IRS and Treasury Department for $10 billion, as he accuses the federal agencies of a failure to prevent a leak of the president’s tax information to news outlets between 2018 and 2020.

The suit, filed in a Florida federal court Thursday, includes the president’s sons Eric Trump and Donald Trump Jr. and the Trump organization as plaintiffs.

The filing alleges that the leak of Trump and the Trump Organization’s confidential tax records caused “reputational and financial harm, public embarrassment, unfairly tarnished their business reputations, portrayed them in a false light, and negatively affected President Trump, and the other Plaintiffs’ public standing.”

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In 2024, former IRS contractor Charles Edward Littlejohn of Washington, D.C. — who worked for Booz Allen Hamilton, a defense and national security tech firm — was sentenced to five years in prison after pleading guilty to leaking tax information about Trump and others to news outlets.

Littlejohn, known as Chaz, gave data to The New York Times and ProPublica between 2018 and 2020 in leaks that appeared to be “unparalleled in the IRS’s history,” prosecutors said.

The disclosure violated IRS Code 6103, one of the strictest confidentiality laws in federal statute.

The Times reported in 2020 that Trump did not pay federal income tax for many years prior to 2020, and ProPublica in 2021 published a series about discrepancies in Trump’s records. Six years of Trump’s returns were later released by the then-Democratically controlled House Ways and Means Committee.

Trump’s suit states that Littlejohn’s disclosures to the news organizations “caused reputational and financial harm to Plaintiffs and adversely impacted President Trump’s support among voters in the 2020 presidential election.”

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Littlejohn stole tax records of other mega-billionaires, including Jeff Bezos and Elon Musk.

The president’s suit comes after the U.S. Treasury Department announced it has cut its contracts with Booz Allen Hamilton, earlier this week, after Littlejohn, who worked for the firm, was charged and subsequently imprisoned for leaking tax information to news outlets about thousands of the country’s wealthiest people, including the president.

Treasury Secretary Scott Bessent said at the time of the announcement that the firm “failed to implement adequate safeguards to protect sensitive data, including the confidential taxpayer information it had access to through its contracts with the Internal Revenue Service.”

Representatives of the White House, Treasury and IRS were not immediately available for comment.

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Map: 4.2-Magnitude Earthquake Shakes Montana

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Map: 4.2-Magnitude Earthquake Shakes Montana

Note: Map shows the area with a shake intensity of 3 or greater, which U.S.G.S. defines as “weak,” though the earthquake may be felt outside the areas shown.  All times on the map are Mountain time. The New York Times

A light, 4.2-magnitude earthquake struck in Montana on Thursday, according to the United States Geological Survey.

The temblor happened at 12:41 p.m. Mountain time about 7 miles northeast of Malmstrom Air Force Base, Mont., data from the agency shows.

As seismologists review available data, they may revise the earthquake’s reported magnitude. Additional information collected about the earthquake may also prompt U.S.G.S. scientists to update the shake-severity map.

Source: United States Geological Survey | Notes: Shaking categories are based on the Modified Mercalli Intensity scale. When aftershock data is available, the corresponding maps and charts include earthquakes within 100 miles and seven days of the initial quake. All times above are Mountain time. Shake data is as of Thursday, Jan. 29 at 2:56 p.m. Eastern. Aftershocks data is as of Thursday, Jan. 29 at 5:42 p.m. Eastern.

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Medicare Advantage insurers face new curbs on overcharges in Trump plan

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Medicare Advantage insurers face new curbs on overcharges in Trump plan

Dr. Mehmet Oz leads the Centers for Medicare & Medicaid Services. A CMS plan to keep payments to Medicare Advantage flat in 2027 roiled health insurance stocks this week.

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Medicare Advantage health plans are blasting a government proposal this week that would keep their reimbursement rates flat next year while making other payment changes.

But some health policy experts say the plan could help reduce billions of dollars in overcharges that have been common in the program for more than a decade.

On Jan. 26, Centers for Medicare & Medicaid Services officials announced they planned to raise rates paid to health plans by less than a tenth of a percent for 2027, far less than the industry expected. Some of the largest, publicly traded insurers, such as UnitedHealth Group and Humana, saw their stock prices plummet as a result, while industry groups threatened that people 65 and older could see service cuts if the government didn’t kick in more money.

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In Medicare Advantage, the federal government pays private insurance companies to manage health care for people who are 65 and older or disabled. 

“Chart reviews”

Less noticed in the brouhaha over rates: CMS also proposed restricting plans from conducting what are called “chart reviews” of their customers. These reviews can result in new medical diagnoses, sometimes including conditions patients haven’t even asked their doctors to treat, that increase government payments to Medicare Advantage plans.

The practice has been criticized for more than a decade by government auditors who say it has triggered billions of dollars in overpayments to the health plans. Earlier this month, the Justice Department announced a record $556 million settlement with the nonprofit health system Kaiser Permanente over allegations the company added about half a million diagnoses to its Advantage patients’ charts from 2009 to 2018, generating about $1 billion in improper payments.

KP did not admit any wrongdoing as part of the settlement.

“I do think the administration is serious about cracking down on overpayments,” said Spencer Perlman, a health care policy analyst in Bethesda, Maryland.

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Perlman said that while the Trump administration strongly supports Medicare Advantage, officials are “troubled” by plans that rake in undue profits by using chart reviews to bill the government for medical conditions even when no treatment was provided.

In a news release, CMS Administrator Mehmet Oz said curbing this practice would ensure more accurate payments to the plans while “protecting taxpayers from unnecessary spending that is not oriented towards addressing real health needs.”

“These proposed payment policies are about making sure Medicare Advantage works better for the people it serves,” Oz said.

Richard Kronick, a former federal health policy researcher and a professor at the University of California-San Diego, called the proposal “at least a mildly encouraging sign,” though he said he suspected health plans might eventually find a way around it.

Kronick has argued that switching seniors to Medicare Advantage plans has cost taxpayers tens of billions of dollars more than keeping them in the government-run Medicare program, because of unbridled medical coding excesses. The insurance plans have grown dramatically in recent years and now enroll about 34 million members, or more than half of people eligible for Medicare.

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David Meyers, an associate professor at the Brown University School of Public Health, called the proposed restriction on chart reviews “a step in the right direction.”

“I think the administration has been signaling pretty strongly they want to cut back on inefficiencies,” he said.

The outcry from industry, mostly directed at the proposal to essentially hold Medicare Advantage payment rates flat, was quick and sharp.

“If finalized, this proposal could result in benefit cuts and higher costs for 35 million seniors and people with disabilities when they renew their Medicare Advantage coverage in October 2026,” said Chris Bond, a spokesperson for AHIP, formerly known as America’s Health Insurance Plans.

CMS is accepting public comments on the proposal and says it will issue a final decision on the payment rates and other provisions by early April.

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Meyers said health plans often claim they will be forced to slash benefits when they aren’t satisfied with CMS payments. But that rarely happens, he said.

“The plans can still make money,” he said. “They mostly are very profitable, just not as profitable as shareholders expected.”

The government pays Medicare Advantage plans higher rates to cover sicker patients. But over the past decade, dozens of whistleblower lawsuits, government audits, and other investigations have alleged that health plans exaggerate how sick their customers are to pocket payments they don’t deserve, a tactic known in the industry as “upcoding.”

Many Medicare Advantage health plans have hired medical coding and analytics consultants to review patients’ medical charts to find new diagnoses that they then bill to the government. Medicare rules require that health plans document — and treat — all medical conditions they bill.

Yet federal audits have shown for years that many health plans’ billing practices don’t hold up to scrutiny.

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A December 2019 report by the Department of Health and Human Services inspector general found that the health plans “almost always” used chart reviews to add, rather than delete, diagnoses. “Over 99 percent of chart reviews in our review added diagnoses,” investigators said.

The report found that diagnoses reported only on chart reviews — and not on any service records — resulted in an estimated $6.7 billion in payments for 2017.

This week’s proposal is not the first time CMS has tried to crack down on chart reviews.

In January 2014, federal officials drafted a plan to restrict the practice, only to abruptly back off a few months later amid what one agency official described as an “uproar” from the industry.

The health insurance industry has for years relied on aggressive lobbying and public relations campaigns to fight efforts to rein in overpayments or otherwise reduce taxpayers’ costs for Medicare Advantage.

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What happens this time will say a lot about the seriousness of the Trump administration in its crack down on controversial, long-standing payment practices in the program.

Perlman, the policy analyst, said it is “quite common” for CMS to partially backtrack when faced with opposition from the industry, such as by phasing in changes over several years to soften the blow on health plans.

David Lipschutz, an attorney with the Center for Medicare Advocacy, a nonprofit public interest law firm, said finalizing the chart review proposal “would be a meaningful step towards reining in overpayments to Medicare Advantage plans.

“But in the past, he said, even a minor change to Advantage payments has led the industry to protest that “the sky will fall as a result, and the proposal is usually dropped.”

“It’s hard to tell at this stage how this will play out,” Lipschutz said.

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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF.

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