Payers
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Consolidated systems charge more for ‘marginally’ better care, study finds
Care delivered by physicians in health systems costs between 12% and 26% higher than care delivered by independent...
FTC unlikely to challenge UnitedHealth-LHC Group deal: report
The Federal Trade Commission is not expected to challenge UnitedHealth Group's acquisition of home health firm LHC Group,...
How BCBS Tennessee will use its 1st ever health equity report
BlueCross BlueShield of Tennessee has completed its first annual health equity report and will use the findings as a...
How BCBS Massachusetts is using AI to fight fraud
Blue Cross Blue Shield of Massachusetts is using artificial intelligence to detect more fraudulent claims, an issue that...
Lawmakers reintroduce bill to rename Medicare Advantage plans
A trio of U.S. representatives has reintroduced a bill that would rename Medicare Advantage plans, prohibit private...
Senators probe payer mental healthcare ‘ghost networks’
A group of senators is seeking answers from major payers over "ghost networks" that make it difficult for patients to find...
CMS to crack down on Medicare Advantage audits, poised to claw back billions of dollars from insurers
Federal regulators have raised concerns about alleged payment abuses in the MA program for years, specifically for those...
7 reactions to CMS’ Medicare Advantage audit ruling
Organizations representing payers say tougher auditing standards CMS will impose on Medicare Advantage plans could create...
New Mexico cancels Medicaid procurement process following leadership shakeup
New Mexico has canceled its current Medicaid contract procurement process as the state's Human Services Department director...
Molina names Nebraska market president
Molina Healthcare named Frank Clepper as plan president for the payer's Nebraska operations.
CMS announces special ACA enrollment period for those losing Medicaid coverage
CMS is opening an ACA special enrollment period for those losing coverage after the end of Medicaid's continuous enrollment...
Government Lets Health Plans That Ripped Off Medicare Keep the Money
Medicare Advantage plans for seniors dodged a major financial bullet Monday as government officials gave them a reprieve...
In blow to payers, CMS implements tougher Medicare Advantage audits
CMS will implement stricter audits on Medicare Advantage plans, a move that could leave payers on the hook for billions of...
HHS wants to strengthen contraceptive coverage requirements
HHS is proposing a new pathway for no-cost contraceptive coverage for employees of organizations with religious objections...
How states are preparing for Medicaid redeterminations
State Medicaid departments had been waiting for more than a year for certainty of when the unwinding of Medicaid's...

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