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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.
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.
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.
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.
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.
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.
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.
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.
The National Quarantine Center is located at the University of Nebraska Medical Center in Omaha.
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Sixteen of the 18 passengers transferred to the U.S. from a cruise ship where there was an outbreak of hantavirus arrived in Omaha, Neb., on Monday for evaluation after disembarking the vessel in Spain’s Canary Islands over the weekend.
Of the 15 U.S. citizens and one dual U.S.-British citizen who arrived in Nebraska, all but one are currently being housed in the National Quarantine Unit. That patient tested positive for the virus and was being housed in the Nebraska Biocontainment Unit, officials said at a Monday news conference. The 15 people in the quarantine unit will continue to be monitored for signs of the illness.
Passengers carry their belongings in plastic bags after being evacuated from the MV Hondius after docking in the Granadilla Port on Sunday in Tenerife, part of the Canary Islands, Spain.
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Nebraska may seem an unlikely location to process these individuals, but it is home to the National Quarantine Unit — the only federally funded quarantine unit in the U.S. — and the separate Nebraska Biocontainment Unit. They are highly specialized facilities located at the University of Nebraska Medical Center (UNMC) and widely considered among the best in the world.
The $1 million, five-room biocontainment unit was dedicated in 2005. It was a joint project with Nebraska Health and Human Services and the UNMC. It is set up to safely provide medical care for patients with highly hazardous and infectious diseases and was used in 2014 to treat two doctors infected with Ebola. The National Quarantine Unit was completed in late 2019. It cost nearly $20 million, according to the Associated Press. Both facilities were used during the COVID-19 epidemic.
“We are prepared for situations exactly like this,” Dr. Michael Ash, CEO of Nebraska Medicine, said in a statement. “Our teams have trained for decades alongside federal and state partners to make sure we can safely provide care while protecting our staff and the broader community. We are proud to support this national effort.”
Two additional U.S. passengers on the cruise ship — a couple, with one showing symptoms of hantavirus — were transferred for monitoring to Emory University Hospital, where another advanced biocontainment facility is located.
When the biocontainment unit was first dedicated more than 20 years ago, the biggest concerns were anthrax attacks and severe acute respiratory syndrome, more commonly known as SARS, Dr. Phil Smith, who spearheaded the efforts at Nebraska Medical Center to create the biocontainment unit, told the AP in 2020. Smith died last year.
A hallway leading to rooms at the Nebraska Biocontainment Unit at the University of Nebraska Medical Center.
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The quarantine unit features 20 negative-pressure rooms designed to keep potentially harmful particles from escaping by maintaining lower air pressure inside than outside the rooms. The single-occupancy rooms provide patients with attached bathrooms, exercise equipment and Wi-Fi, according to the medical center.
“We have protocols in the quarantine unit that provide for safe care of these of these persons, including just all the activities of daily living so that they can … have a comfortable stay but also have it in an area that’s protected and limits spread of the pathogen,” Dr. Michael Wadman, the medical director of the National Quarantine Unit, said at a Friday news conference.
The biocontainment unit, by contrast, is a patient-care space where people are able to receive medical treatment, Dr. Angela Hewlett, medical director of the biocontainment unit, told reporters Monday.
She emphasized that the facility — which has a 10-bed capacity — operates independently from the quarantine unit and has its own dedicated air-handling system. “We don’t share [it] with any of the rest of the facility,” she said, noting that the unit uses rooftop HEPA filtration and is designed “very differently” from what most people typically imagine in a hospital setting.
One of the rooms in the Nebraska Biocontainment Unit.
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Nebraska Gov. Jim Pillen, speaking at Monday’s news conference, welcomed the recently arrived patients, who are among nearly 150 people from 23 different countries who were aboard the MV Hondius when the illness most commonly transmitted to humans through contact with infected rodents broke out. As of Monday, the World Health Organization has reported at least nine cases of hantavirus, including three deaths.
“We’re glad that you’re here,” Pillen said. “We’re going to ensure that you have the best world-class care possible.”
Pillen also sought to reassure Nebraskans that the facilities are safe and secure: “We’re working diligently to ensure no one leaves the security in an unsecured way at an inappropriate time,” he said. “No one poses a risk to public health, just walking out the front door of the streets of Omaha.”
The hantavirus outbreak on the cruise ship has been identified as the Andes strain of the illness, one that can be spread, though rarely, from person-to-person, according to the Centers for Disease Control and Prevention. It can cause severe respiratory disease, with early flu-like symptoms.
“The Andes variant of this virus does not spread easily, and it requires prolonged, close contact with someone who is already symptomatic,” according to Adm. Brian Christine, the assistant secretary for health at the U.S. Department of Health and Human Services, who spoke at Monday’s news conference. “Even so, we have taken this situation very seriously from the very start.”
“The risk of hantavirus to the general public remains very, very low,” he said.
The full quarantine period for hantavirus is 42 days, Christine said, but he added that the patients would be allowed to go home if they remained asymptomatic.
“Right now, the passengers that are all in the assessment phase — they’re going to be here for at least a few days while we do assessments and the coordination on what happens next,” he said, adding that they had the option to remain in the quarantine facility for the full period, for “the safest and most effective option for them.”
new video loaded: Americans Exposed to Hantavirus on Cruise Ship Arrive in United States
transcript
transcript
Americans Exposed to Hantavirus on Cruise Ship Arrive in United States
Eighteen passengers who were aboard the MV Hondius, a cruise ship with a deadly hantavirus outbreak, landed in Omaha on a U.S. government medical flight. The passengers were being monitored at medical facilities in Nebraska and Georgia.
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We’re working diligently to ensure no one leaves the security in an unsecured way at an inappropriate time. No one who poses a risk to public health is walking out the front door of the streets of Omaha or beyond.
By Axel Boada
May 11, 2026
The man charged with attempting to assassinate President Donald Trump at the White House Correspondents’ Association dinner last month pleaded not guilty at a Monday arraignment in federal court.
Cole Tomas Allen, 31, wearing an orange shirt and trousers, was handcuffed and shackled as he was brought into the courtroom in Washington, D.C., federal court. His handcuffs were attached to a chain around his waist, which clanked as he was led to the defense table.
Speaking on behalf of Allen, federal public defender Tezira Abe said her client “pleads not guilty to all four counts as charged,” including attempting to assassinate the president of the United States, in connection with the April 25 incident at the Washington Hilton hotel.
Assistant U.S. Attorney Charles Jones advised the court that they plan to start producing their first tranche of discovery to the defense by the end of the week.
Officials said Allen, a California teacher and engineer, was armed with multiple guns, as well as knives, when he sprinted through a security checkpoint near the event where Trump and other White House officials had gathered with journalists.
He was arrested after an exchange of gunfire with a U.S. Secret Service officer who fired at him multiple times, a criminal complaint said. Allen was not shot during the exchange. The officer, who was wearing a ballistic vest, was shot once in the chest, treated at a hospital and released.
Trump and top members of his Cabinet and Congress were quickly evacuated from the room as others ducked under tables.
Allen was initially charged with attempting to assassinate the president, transportation of a firearm and ammunition through interstate commerce with intent to commit a felony, and discharge of a firearm during a crime of violence. On Tuesday, a federal grand jury indicted him on a new charge in the shooting of a Secret Service agent.
Moments before the attack, Allen had sent his family members a note apologizing and criticizing Trump without mentioning the president by name, according to a transcript of some of his writings provided to NBC News by a senior administration official. Allen also wrote that “administration officials (not including Mr. Patel)” were “targets.”
He also appeared to have taken a selfie in his hotel room. Prosecutors said Allen, who was dressed in a black button-down shirt and black pants, was “wearing a small leather bag consistent in appearance with the ammunition-filled bag later recovered from his person,” as well as a shoulder holster, a sheathed knife, pliers and wire cutters.
Officials have said they believe Allen had traveled by train from California to Washington, D.C., before checking into the hotel.
Allen’s sister, Avriana Allen, told law enforcement that her brother would make radical comments and constantly referenced a plan to fix the world, but said their parents were unaware that he had firearms in the home and that he would regularly train at shooting ranges.
Records show that he had purchased a Maverick 12-gauge shotgun in August 2025 and an Armscor Precision .38 semiautomatic pistol in October 2023.
After his arrest, Allen told the FBI that he did not expect to survive the incident, according to Assistant U.S. Attorney Jocelyn Ballantine. He was briefly placed on suicide watch at the Washington, D.C., jail, where he’s being held.
Allen is expected to appear in court for a June 29 hearing.
At Monday’s arraignment, his legal team said they plan on asking for the “entire office” of the U.S. attorney for the District of Columbia to be recused because of U.S. Attorney Jeanine Pirro’s apparent involvement in the case in a “supervisory role.” Federal public defender Eugene Ohm said some of the evidence they receive from the government will further inform that decision.
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