Latest news with #Medicare-related
The Advertiser
02-07-2025
- Health
- The Advertiser
Doctors dispute billions being lost in Medicare fraud
Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, a health union says. But the peak professional body representing doctors says the numbers don't add up in a Health Services Union (HSU) report that paints a picture of fraud in the $30 billion Medicare Benefits Schedule scheme. Leaning on previous analyses, the report estimated fraud and non-compliance rates to range from five-to-30 per cent. It described one estimate of $10 billion in bogus claims as a figure that "cannot be definitively disproven" due to no effective system to measure fraud and non-compliant billing in the first place. The report published on Wednesday found about three-in-five medical professionals referred to the Medicare-related watchdog in 2024 were GPs. But the union said it suspects the watchdog was not adequately investigating specialists and other non-GP billers, representing nearly 70 per cent of all Medicare claims. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two-thirds of Professional Services Review case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners. The union, which represents more than 50,000 health workers including in hospitals and pathologies, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published on Wednesday said. But the association lambasted the union's claims as "baseless" insisting that it was getting on "with the job of pursuing meaningful reforms". The government-commissioned Philip review in 2023 found Medicare compliance issues were overwhelmingly caused by the complexity of the system, it said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, a health union says. But the peak professional body representing doctors says the numbers don't add up in a Health Services Union (HSU) report that paints a picture of fraud in the $30 billion Medicare Benefits Schedule scheme. Leaning on previous analyses, the report estimated fraud and non-compliance rates to range from five-to-30 per cent. It described one estimate of $10 billion in bogus claims as a figure that "cannot be definitively disproven" due to no effective system to measure fraud and non-compliant billing in the first place. The report published on Wednesday found about three-in-five medical professionals referred to the Medicare-related watchdog in 2024 were GPs. But the union said it suspects the watchdog was not adequately investigating specialists and other non-GP billers, representing nearly 70 per cent of all Medicare claims. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two-thirds of Professional Services Review case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners. The union, which represents more than 50,000 health workers including in hospitals and pathologies, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published on Wednesday said. But the association lambasted the union's claims as "baseless" insisting that it was getting on "with the job of pursuing meaningful reforms". The government-commissioned Philip review in 2023 found Medicare compliance issues were overwhelmingly caused by the complexity of the system, it said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, a health union says. But the peak professional body representing doctors says the numbers don't add up in a Health Services Union (HSU) report that paints a picture of fraud in the $30 billion Medicare Benefits Schedule scheme. Leaning on previous analyses, the report estimated fraud and non-compliance rates to range from five-to-30 per cent. It described one estimate of $10 billion in bogus claims as a figure that "cannot be definitively disproven" due to no effective system to measure fraud and non-compliant billing in the first place. The report published on Wednesday found about three-in-five medical professionals referred to the Medicare-related watchdog in 2024 were GPs. But the union said it suspects the watchdog was not adequately investigating specialists and other non-GP billers, representing nearly 70 per cent of all Medicare claims. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two-thirds of Professional Services Review case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners. The union, which represents more than 50,000 health workers including in hospitals and pathologies, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published on Wednesday said. But the association lambasted the union's claims as "baseless" insisting that it was getting on "with the job of pursuing meaningful reforms". The government-commissioned Philip review in 2023 found Medicare compliance issues were overwhelmingly caused by the complexity of the system, it said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, a health union says. But the peak professional body representing doctors says the numbers don't add up in a Health Services Union (HSU) report that paints a picture of fraud in the $30 billion Medicare Benefits Schedule scheme. Leaning on previous analyses, the report estimated fraud and non-compliance rates to range from five-to-30 per cent. It described one estimate of $10 billion in bogus claims as a figure that "cannot be definitively disproven" due to no effective system to measure fraud and non-compliant billing in the first place. The report published on Wednesday found about three-in-five medical professionals referred to the Medicare-related watchdog in 2024 were GPs. But the union said it suspects the watchdog was not adequately investigating specialists and other non-GP billers, representing nearly 70 per cent of all Medicare claims. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two-thirds of Professional Services Review case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners. The union, which represents more than 50,000 health workers including in hospitals and pathologies, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published on Wednesday said. But the association lambasted the union's claims as "baseless" insisting that it was getting on "with the job of pursuing meaningful reforms". The government-commissioned Philip review in 2023 found Medicare compliance issues were overwhelmingly caused by the complexity of the system, it said. AAP has approached federal Health Minister Mark Butler for comment.
The Advertiser
02-07-2025
- Health
- The Advertiser
Union says 'billions down the drain' in Medicare fraud
Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, adding up to billions being wasted yearly, the Health Service Union says. The union's calculations are based on previous analyses, such as the government-commissioned Independent Review of Medicare Integrity and Compliance in 2023. They estimated fraud and non-compliance rates to range from five-to-30 per cent with a maximum $10 billion cited as a figure that "cannot be definitively disproven, because there is no effective system to measure fraud and non-compliant billing in the first place". In a report published on Wednesday, the union found about 60 per cent of medical professionals referred to Professional Services Review (PSR), which investigates cases of Medicare-related "inappropriate practices", in 2024 were GPs. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two thirds of PSR case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners about the union's findings. The union, which represents more than 50,000 members across public and private hospitals as well as in other sectors such aged care and pathology, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published Wednesday said. The AMA has been contacted for comment."Every dollar lost to Medicare fraud is a dollar taken from hospitals and the most vulnerable Australians who rely on our public health system," Mr Hayes said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, adding up to billions being wasted yearly, the Health Service Union says. The union's calculations are based on previous analyses, such as the government-commissioned Independent Review of Medicare Integrity and Compliance in 2023. They estimated fraud and non-compliance rates to range from five-to-30 per cent with a maximum $10 billion cited as a figure that "cannot be definitively disproven, because there is no effective system to measure fraud and non-compliant billing in the first place". In a report published on Wednesday, the union found about 60 per cent of medical professionals referred to Professional Services Review (PSR), which investigates cases of Medicare-related "inappropriate practices", in 2024 were GPs. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two thirds of PSR case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners about the union's findings. The union, which represents more than 50,000 members across public and private hospitals as well as in other sectors such aged care and pathology, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published Wednesday said. The AMA has been contacted for comment."Every dollar lost to Medicare fraud is a dollar taken from hospitals and the most vulnerable Australians who rely on our public health system," Mr Hayes said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, adding up to billions being wasted yearly, the Health Service Union says. The union's calculations are based on previous analyses, such as the government-commissioned Independent Review of Medicare Integrity and Compliance in 2023. They estimated fraud and non-compliance rates to range from five-to-30 per cent with a maximum $10 billion cited as a figure that "cannot be definitively disproven, because there is no effective system to measure fraud and non-compliant billing in the first place". In a report published on Wednesday, the union found about 60 per cent of medical professionals referred to Professional Services Review (PSR), which investigates cases of Medicare-related "inappropriate practices", in 2024 were GPs. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two thirds of PSR case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners about the union's findings. The union, which represents more than 50,000 members across public and private hospitals as well as in other sectors such aged care and pathology, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published Wednesday said. The AMA has been contacted for comment."Every dollar lost to Medicare fraud is a dollar taken from hospitals and the most vulnerable Australians who rely on our public health system," Mr Hayes said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, adding up to billions being wasted yearly, the Health Service Union says. The union's calculations are based on previous analyses, such as the government-commissioned Independent Review of Medicare Integrity and Compliance in 2023. They estimated fraud and non-compliance rates to range from five-to-30 per cent with a maximum $10 billion cited as a figure that "cannot be definitively disproven, because there is no effective system to measure fraud and non-compliant billing in the first place". In a report published on Wednesday, the union found about 60 per cent of medical professionals referred to Professional Services Review (PSR), which investigates cases of Medicare-related "inappropriate practices", in 2024 were GPs. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two thirds of PSR case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners about the union's findings. The union, which represents more than 50,000 members across public and private hospitals as well as in other sectors such aged care and pathology, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published Wednesday said. The AMA has been contacted for comment."Every dollar lost to Medicare fraud is a dollar taken from hospitals and the most vulnerable Australians who rely on our public health system," Mr Hayes said. AAP has approached federal Health Minister Mark Butler for comment.
Yahoo
09-06-2025
- Business
- Yahoo
5 Major Social Security Mistakes Boomers Can't Stop Making
Retirement planning is both complicated and high-stakes — a recipe for mistakes with major financial consequences. And sure enough, Business Insider reported that more than half of Americans over 65 earn less than $30,000 a year. As you plan your own retirement, watch out for these Social Security mistakes plaguing current baby boomers. Check Out: Read Next: Too many people reach their early 60s and think: 'I've been paying into the system for decades, I need to lock in my share!' Unfortunately, that leaves them with far lower lifetime benefits than if they'd waited. 'Filing early means locking in a permanent reduction in benefits, up to 30% if your full retirement age is 67,' explained Christine M. Parisi, senior wealth advisor at R.W. Rogé & Company. If you take benefits at age 62, you receive just 70% of your full retirement benefit. At 67, you collect 100%. Wait until 70, and you receive 124% of your full Social Security benefit. Learn More: Plan to continue working for a while? Hold off on taking Social Security — and not just to secure higher benefits. 'If your earnings exceed the annual limit, the Social Security Administration may withhold $1 in benefits for every $2 you earn over the threshold,' Parisi added. 'Benefits can also push your income higher for Medicare-related costs like IRMAA, meaning you could end up paying more in premiums.' Plus, combining your salary with Social Security can push you into a higher tax bracket. You can end up handing much of that money right back to Uncle Sam. If one spouse earned significantly higher income, or worked for many years longer, their benefits will be higher. Plan to optimize those, perhaps by having that spouse delay benefits while the family lives on earned income or distributions from retirement accounts before taking benefits. Parisi noted that different rules apply to surviving spouses. 'If your late spouse worked long enough to qualify for Social Security, you may be able to start collecting survivor benefits as early as age 60. Unfortunately, many don't realize this is even an option until it's too late.' First and foremost, when you planned your retirement income, did you account for taxes? You'll still owe income taxes in retirement, at least under current tax laws. 'A portion of Social Security benefits are taxable, up to 85%, based on your provisional income,' said Keith Hensley of Florida Financial Planning. Many states tax Social Security benefits as well. The upshot? You may need more money saved for retirement than you thought. Again, you may be better off working another year and delaying Social Security benefits. It may not be too late for a Roth conversion to make sense. If you have a year with lower income, consider taking the tax hit and converting some of your traditional retirement funds to Roth accounts, so they can compound tax-free and you can avoid paying taxes on withdrawals in retirement. If Social Security is your only — or your primary — plan for retirement income, expect stormy seas ahead. William Connor, CFA and CFP with Sax Wealth Advisors, added some historical context. 'Social Security was created as a safety net for older Americans. It was not designed as a primary source of retirement income, and won't replace your working income.' Instead, combine it with other sources of income such as retirement accounts, health savings accounts (HSAs), taxable brokerage accounts, real estate investments and perhaps part-time fun working gigs. The less you rely on Social Security income, the more comfortable and secure your retirement will be. More From GOBankingRates 3 Luxury SUVs That Will Have Massive Price Drops in Summer 2025 8 Common Mistakes Retirees Make With Their Social Security Checks How Much Money Is Needed To Be Considered Middle Class in Every State? This article originally appeared on 5 Major Social Security Mistakes Boomers Can't Stop Making Sign in to access your portfolio
Yahoo
04-06-2025
- Business
- Yahoo
Cigna, Allegheny Health Network contract dispute threatens in-network access for thousands
Thousands of Cigna commercially insured people in the Pittsburgh region could lose in-network access to Allegheny Health Network by the end of June in a dispute over a new contract. AHN patients who use Cigna were notified this week of the impasse in negotiations on a new contract, meaning most care would be out of network if there isn't a new contract in place by June 30, according to a copy of a letter obtained by the Pittsburgh Business Times. About 20,000 Cigna members have used an AHN provider within the past year. It's the second such dispute in the past two years. The contract that runs out is for commercially insured members and not for Medicare or Medicare Advantage members. Cigna in March 2025 sold the Medicare-related business to Health Care Service Corp., a Chicago-based insurer. HCSC's coverage of Medicare and Medicare Advantage patients isn't impacted by this dispute and those patients will continue to have in-network access to AHN no matter what happens to the commercial insurance agreement. Click here to read more from our partners at the Pittsburgh Business Times. Download the FREE WPXI News app for breaking news alerts. Follow Channel 11 News on Facebook and Twitter. | Watch WPXI NOW
Forbes
02-05-2025
- Business
- Forbes
Cigna Profits Hit $1.3 Billion As Health Insurer Gets Handle On Costs
The Cigna Group swung to a first quarter profit of $1.3 billion as the health insurer begins to gain control of rising medical costs and its Evernorth business continues to perform well. Cigna, which includes Evernorth Health Services and one of the nation's largest pharmacy benefit management companies, said first quarter net income was $1.3 billion, or $4.85 per share, compared with a net loss of $277 million, or 97 cents per share, in the first quarter of last year. Total revenues for the first quarter jumped 14% to $65.5 billion 'reflecting growth of existing client relationships and strong specialty pharmacy growth in Evernorth Health Services,' Cigna said in its first quarter earnings report released Friday. The potential for future growth and a health insurance business with potentially lower costs thanks to a divestiture of Medicare-related businesses figured in Cigna's newly disclosed financial outlook released Friday showing more promising earnings for the rest of 2025. Like other health insurers, Cigna has been grappling with rising medical costs and the first quarter was no different. Cigna's medical cost ratio (MCR), which is the percentage of premium revenue that goes toward medical costs, was 82.2% for the first quarter of 2025 compared to 79.9% for first quarter of last year. 'The increase for the first quarter was primarily driven by expected higher stop loss medical costs,' Cigna said in its report. Meanwhile, Cigna said its sale of its Medicare health benefits businesses to Health Care Service Corp. in late March 'closed later than the company's financial planning assumptions, increasing the first quarter Cigna Healthcare MCR as the Medicare businesses operate at a higher MCR compared to the rest of the portfolio.' Looking ahead, however, Medicare costs won't be an issue for Cigna like its rivals that operate Medicare Advantage plans for seniors. Operators of Medicare Advantage have been hit hard in the last year with higher costs that have spilled over on to their stock prices. Medicare Advantage plans contract with the federal government to provide extra benefits and services to seniors, such as disease management and nurse help hotlines with some also offering vision, dental care and wellness programs. During the first quarter, Cigna closed the sale of its Medicare health benefits businesses and a medical care provider services operation for $3.3 billion to Health Care Service Corp., the parent of five Blue Cross and Blue Shield health insurance plans. Health Care Service, which operates Blue Cross and Blue Shield health plans in five states, now owns Cigna's Medicare Advantage plans, Cigna supplemental benefits, Medicare Part D drug benefits and CareAllies, a business that helps medical care providers with various administrative services and contracting. Cigna's focus is now on its businesses that include commercial health plans, administration of health benefits for employers and its Evernorth health services business that includes the large pharmacy benefit manager, Express Scripts. 'We are building a more sustainable health care model by successfully delivering on our series of commitments and actions to improve transparency and support for our customers and patients,' said Cigna chairman and chief executive officer David M. Cordani. 'Our strong first quarter results and increase in outlook for full-year earnings reflects the strength of our Evernorth Health Services and Cigna Healthcare growth platforms in a dynamic environment.' Cigna said its outlook for full year 2025 consolidated adjusted income from operations is $29.60 per share.
