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Two dead after cargo plane skids off Hong Kong runway



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September 24, 2025
Sept. 24, 2025, 5:00 AM EDTBy Lauren Sausser and Darius Tahir | KFF Health NewsTaking a page from the private insurance industry’s playbook, the Trump administration will launch a program next year to find out how much money an artificial intelligence algorithm could save the federal government by denying care to Medicare patients.The pilot program, designed to weed out wasteful, “low-value” services, amounts to a federal expansion of an unpopular process called prior authorization, which requires patients or someone on their medical team to seek insurance approval before proceeding with certain procedures, tests, and prescriptions. It will affect Medicare patients, and the doctors and hospitals who care for them, in Arizona, Ohio, Oklahoma, New Jersey, Texas, and Washington, starting Jan. 1 and running through 2031.The move has raised eyebrows among politicians and policy experts. The traditional version of Medicare, which covers adults 65 and older and some people with disabilities, has mostly eschewed prior authorization. Still, it is widely used by private insurers, especially in the Medicare Advantage market.And the timing was surprising: The pilot was announced in late June, just days after the Trump administration unveiled a voluntary effort by private health insurers to revamp and reduce their own use of prior authorization, which causes care to be “significantly delayed,” said Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services.“It erodes public trust in the health care system,” Oz told the media. “It’s something that we can’t tolerate in this administration.”But some critics, like Dr. Vinay Rathi, an Ohio State University doctor and policy researcher, have accused the Trump administration of sending mixed messages.On one hand, the federal government wants to borrow cost-cutting measures used by private insurance, he said. “On the other, it slaps them on the wrist.”Administration officials are “talking out of both sides of their mouth,” said Rep. Suzan DelBene, a Washington Democrat. “It’s hugely concerning.”Patients, doctors and other lawmakers have also been critical of what they see as delay-or-deny tactics, which can slow down or block access to care, causing irreparable harm and even death.“Insurance companies have put it in their mantra that they will take patients’ money and then do their damnedest to deny giving it to the people who deliver care,” said Rep. Greg Murphy, a North Carolina Republican and a urologist. “That goes on in every insurance company boardroom.”Insurers have long argued that prior authorization reduces fraud and wasteful spending, as well as prevents potential harm. Public displeasure with insurance denials dominated the news in December, when the shooting death of UnitedHealthcare’s CEO led many to anoint his alleged killer as a folk hero.And the public broadly dislikes the practice: Nearly three-quarters of respondents thought prior authorization was a “major” problem in a July poll published by KFF, a health information nonprofit that includes KFF Health News.Indeed, Oz said during his June press conference that “violence in the streets” prompted the Trump administration to take on the issue of prior authorization reform in the private insurance industry.Still, the administration is expanding the use of prior authorization in Medicare. CMS spokesperson Alexx Pons said both initiatives “serve the same goal of protecting patients and Medicare dollars.”Unanswered questionsThe pilot program, WISeR — short for “Wasteful and Inappropriate Service Reduction” — will test the use of an AI algorithm in making prior authorization decisions for some Medicare services, including skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy.The federal government says such procedures are particularly vulnerable to “fraud, waste, and abuse” and could be held in check by prior authorization.Other procedures may be added to the list. But services that are inpatient-only, emergency or “would pose a substantial risk to patients if significantly delayed” would not be subject to the AI model’s assessment, according to the federal announcement.While the use of AI in health insurance isn’t new, Medicare has been slow to adopt the private-sector tools. Medicare has historically used prior authorization in a limited way, with contractors who aren’t incentivized to deny services. But experts who have studied the plan believe the federal pilot could change that.Pons told KFF Health News that no Medicare request will be denied before being reviewed by a “qualified human clinician,” and that vendors “are prohibited from compensation arrangements tied to denial rates.” While the government says vendors will be rewarded for savings, Pons said multiple safeguards will “remove any incentive to deny medically appropriate care.”“Shared savings arrangements mean that vendors financially benefit when less care is delivered,” a structure that can create a powerful incentive for companies to deny medically necessary care, said Jennifer Brackeen, senior director of government affairs for the Washington State Hospital Association.And doctors and policy experts say that’s only one concern.Rathi said the plan “is not fully fleshed out” and relies on “messy and subjective” measures. The model, he said, ultimately depends on contractors to assess their own results, a choice that makes the results potentially suspect.“I’m not sure they know, even, how they’re going to figure out whether this is helping or hurting patients,” he said.Pons said the use of AI in the Medicare pilot will be “subject to strict oversight to ensure transparency, accountability, and alignment with Medicare rules and patient protection.”“CMS remains committed to ensuring that automated tools support, not replace, clinically sound decision-making,” he said.Experts agree that AI is theoretically capable of expediting what has been a cumbersome process marked by delays and denials that can harm patients’ health. Health insurers have argued that AI eliminates human error and bias and will save the health care system money. These companies have also insisted that humans, not computers, are ultimately reviewing coverage decisions.But some scholars are doubtful that’s routinely happening. “I think that there’s also probably a little bit of ambiguity over what constitutes ‘meaningful human review,’” said Amy Killelea, an assistant research professor at the Center on Health Insurance Reforms at Georgetown University.A 2023 report published by ProPublica found that, over a two-month period, doctors at Cigna who reviewed requests for payment spent an average of only 1.2 seconds on each case.Cigna spokesperson Justine Sessions told KFF Health News that the company does not use AI to deny care or claims. The ProPublica investigation referenced a “simple software-driven process that helped accelerate payments to clinicians for common, relatively low-cost tests and treatments, and it is not powered by AI,” Sessions said. “It was not used for prior authorizations.”And yet class-action lawsuits filed against major health insurers have alleged that flawed AI models undermine doctor recommendations and fail to take patients’ unique needs into account, forcing some people to shoulder the financial burden of their care.Meanwhile, a survey of physicians published by the American Medical Association in February found that 61% think AI is “increasing prior authorization denials, exacerbating avoidable patient harms and escalating unnecessary waste now and into the future.”Chris Bond, a spokesperson for the insurers’ trade group AHIP, told KFF Health News that the organization is “zeroed in” on implementing the commitments made to the government. Those include reducing the scope of prior authorization and making sure that communications with patients about denials and appeals are easy to understand.‘This is a pilot’The Medicare pilot program underscores ongoing concerns about prior authorization and raises new ones.While private health insurers have been opaque about how they use AI and the extent to which they use prior authorization, policy researchers believe these algorithms are often programmed to automatically deny high-cost care.“The more expensive it is, the more likely it is to be denied,” said Jennifer Oliva, a professor at the Maurer School of Law at Indiana University-Bloomington, whose work focuses on AI regulation and health coverage.Oliva explained in a recent paper for the Indiana Law Journal that when a patient is expected to die within a few years, health insurers are “motivated to rely on the algorithm.” As time passes and the patient or their provider is forced to appeal a denial, the chance of the patient dying during that process increases. The longer an appeal, the less likely the health insurer is to pay the claim, Oliva said.“The No. 1 thing to do is make it very, very difficult for people to get high-cost services,” she said.As the use of AI by health insurers is poised to grow, insurance company algorithms amount to a “regulatory blind spot” and demand more scrutiny, said Carmel Shachar, a faculty director at Harvard Law School’s Center for Health Law and Policy Innovation.The WISeR pilot is “an interesting step” toward using AI to ensure that Medicare dollars are purchasing high-quality health care, she said. But the lack of details makes it difficult to determine whether it will work.Politicians are grappling with some of the same questions.“How is this being tested in the first place? How are you going to make sure that it is working and not denying care or producing higher rates of care denial?” asked DelBene, who signed an August letter to Oz with other Democrats demanding answers about the AI program. But Democrats aren’t the only ones worried.Murphy, who co-chairs the House GOP Doctors Caucus, acknowledged that many physicians are concerned the WISeR pilot could overreach into their practice of medicine if the AI algorithm denies doctor-recommended care.Meanwhile, House members of both parties recently supported a measure proposed by Rep. Lois Frankel, a Florida Democrat, to block funding for the pilot in the fiscal 2026 budget of the Department of Health and Human Services.AI in health care is here to stay, Murphy said, but it remains to be seen whether the WISeR pilot will save Medicare money or contribute to the problems already posed by prior authorization.“This is a pilot, and I’m open to see what’s going to happen with this,” Murphy said, “but I will always, always err on the side that doctors know what’s best for their patients.”Lauren Sausser and Darius Tahir | KFF Health NewsLauren Sausser and Darius Tahir | KFF Health News
October 21, 2025
Oct. 21, 2025, 12:50 PM EDTBy Alexander SmithLONDON — Prince Andrew may have given up his titles, but the questions about his relationship with Jeffrey Epstein haven’t given up on him — or Britain’s embattled royal family.Seemingly every day, damaging new reports emerge about Andrew, 65, his friendship with the late pedophile financier, and allegations the prince had sex with trafficked Epstein victim Virginia Roberts Giuffre when she was 17, which he denies.In her posthumous memoir “Nobody’s Girl” released Tuesday, Giuffre, who died by suicide in April at age 41, said Andrew acted as though having sex with her “was his birthright.” Andrew, who in February 2022 reached a legal settlement with Giuffre after she filed a civil case against him in a New York court, has repeatedly denied having met her.’Nobody’s Girl’ by Virginia Giuffre on display at a bookshop in London on Tuesday.Ming Yeung / Getty ImagesBut the rolling scandal refuses to go away, and has the potential to inflict further damage on a monarchy whose popularity continues to dwindle after the death of the widely beloved Queen Elizabeth II in 2022. King Charles III has sought to insulate “the Firm” from the cloud over his younger brother. Andrew said in a statement last week that with Charles’ “agreement,” he would “no longer use my title or the honours which have been conferred upon me,” including Duke of York.But there are still unanswered questions about what the palace knew, and when, with calls from lawmakers and others for the royals to oust Andrew entirely.“The deep and wide support for the queen meant the family was able to better weather all the controversies that could emerge — and this is a bad one,” said Craig Prescott, who teaches law at Royal Holloway, University of London and specializes on the constitutional and political role of the monarchy.“These specific allegations are, of course, extraordinarily damaging in the first place, but they also run counter to some of the causes that members of the royal family take up,” he said.Jeffrey Epstein in 2017.New York State Sex Offender Registry via AP fileFriday’s agreement for Andrew to relinquish his titles came after emails published in documents for a court case not involving the prince showed he had been in contact with Epstein for longer than he previously admitted.That “makes him look, in black and white, a liar,” NBC News’ royal contributor Daisy McAndrew told “TODAY” on Sunday. “And so how can you trust anything else he says?”Then Sunday, London’s Metropolitan Police said it was investigating reports that Andrew had asked one of its officers to dig up dirt on Giuffre. A Buckingham Palace official told NBC News these reports should be “examined in the appropriate way.”Virginia Giuffre (then Roberts) with Prince Andrew and Ghislaine Maxwell at Prince Andrew’s London home, in a photo released with court documents.Monday brought two further revelations: First that Andrew had not paid rent on his Royal Lodge residence for 20 years, revealed in a Freedom of Information request by The Times newspaper to the Crown Estate, which handles royal finances. Neither Andrew nor Buckingham Palace have responded to the report.Then came the publication of Giuffre’s posthumous memoir.She wrote that she had sex with the prince on three occasions, including an “orgy” involving “eight other young girls” who “appeared to be under the age of 18 and didn’t really speak English.”She then suffered three weeks of “irregular bleeding,” before waking up in a “pool of blood” and being taken to hospital by Epstein, she wrote. Epstein, who died by suicide in jail in 2019 shortly after he was arrested on federal sex trafficking charges, later told her she had suffered a miscarriage, and she suspected him of conspiring with the doctor to keep it quiet, Giuffre said.On seeing a photo of Andrew and Epstein walking in New York’s Central Park in 2010 — after Epstein was convicted of soliciting prostitution of someone under the age of 18 — Giuffre wrote she was “revolted to see two of my abusers together, out for a stroll.” But “mostly I was amazed that a member of the Royal Family would be stupid enough to appear in public with Epstein.”Andrew has previously denied these allegations, saying that he has “no recollection of ever meeting this lady, none whatsoever.” In his statement announcing the relinquishment of his titles, he said, “I vigorously deny the accusations against me.”Virginia Giuffre, center, leaves federal court in New York on Aug. 27, 2019.Jeenah Moon / Bloomberg via Getty Images fileThe civil sex abuse lawsuit brought by Giuffre against Andrew was settled out of court for an undisclosed sum.Though Buckingham Palace routinely says it does not speak for the prince, Andrew has enjoyed a prominent role at some recent royal events, including the queen’s funeral.Some lawmakers are demanding that Andrew be formally stripped of his titles by an act of Parliament — a rare foray into regal matters by Britain’s supposedly separate government.The last time this happened was in 1917, when Parliament used the Titles Deprivation Act to strip German members of the British royal family of their titles during World War I.That’s not without risks, according to Prescott at Royal Holloway.”If you have legislation removing the dukedom from Prince Andrew, might a cheeky MP want to table an amendment and remove the dukedom of Sussex from Prince Harry?” he said.The government indicated it does not support this. Education Secretary Bridget Phillipson said Monday that while “our thoughts have to be with the victims of Jeffrey Epstein, these “are matters for the royal family.”The nuclear option would involve the king himself using something called “Letters Patent” to strip Andrew of his designation as prince.In doing so, the palace must weigh distancing itself from Andrew with ensuring the blowback from any further censure does not do even more damage to an institution that requires public buy-in.“It’s true that the monarchy isn’t voted in,” Prescott said. “But if the public mood shifted and people no longer wanted to have the monarchy, then you imagine that politics would follow.”Alexander SmithAlexander Smith is a senior reporter for NBC News Digital based in London.Mahalia Dobson, Max Taylor and Jackson Peck contributed.
October 26, 2025
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