Medicare Advantage Signal Feed
Latest scored signals across all monitored sources.
722 signals
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Florida sues 2 PBMs over alleged price fixing
Florida Attorney General James Uthmeier has filed a lawsuit against Prime Therapeutics and Cigna’s Express Scripts, alleging the pharmacy benefit managers entered into an illegal horizontal price-fixing agreement that threatens access to affordable medications. The lawsuit alleges the competitors entered a “collaboration” in December 2019 under which Prime, which is owned by BCBS plans, adopted […] The post Florida sues 2 PBMs over alleged price fixing appeared first on Becker's Payer Issues...
Cigna + Blue Cross Blue Shield plans · 29 signals · last 30 days -
Federal court denies Elevance’s bid for emergency 2026 star ratings recalculation
A federal judge has denied Elevance Health’s request for an emergency recalculation of its 2026 Medicare Advantage star ratings. On Aug. 27, U.S. District Judge Lisa Godbey Wood ruled that Elevance waited too long to file for the emergency recalculation and failed to show that an injunction would prevent alleged competitive harm. In the same […] The post Federal court denies Elevance’s bid for emergency 2026 star ratings recalculation appeared first on Becker's Payer Issues | Payer News .
ElevanceElevance Health · 11 signals · last 30 days -
Cigna’s ‘industry-first’ supplemental play ties cash benefits to medical claims
Cigna Healthcare is launching a product that bundles supplemental health benefits directly into high-deductible health plans. The product, Medical with Smart Coverage, will be available in 2027 for employers with 500 to 2,999 employees offering qualifying HDHPs. Eligible employees can receive up to $7,000 in supplemental cash benefits when they’re hospitalized or diagnosed with a […] The post Cigna’s ‘industry-first’ supplemental play ties cash benefits to medical claims appeared first on Bec...
CignaCigna · 10 signals · last 30 days -
‘Fundamentally different priorities’: Lee Health to go out of network for UnitedHealthcare members
Fort Myers, Fla.-based Lee Health said it would terminate hospital and physician contracts with UnitedHealthcare at the end of 2026. Beginning Jan. 1, 2027, Lee Health will be out of network for UnitedHealthcare employer-based, individual and Medicare Advantage plan members. Lee Health said UnitedHealthcare does not consider the health system to be part of the […] The post ‘Fundamentally different priorities’: Lee Health to go out of network for UnitedHealthcare members appeared first on Beck...
UnitedHealthcareUnitedHealthcare · 34 signals · last 30 days -
Opinion: A billing code was supposed to incentivize relationship-based primary care for Medicare patients. It may not be working as hoped
Primary care is much more than what happens during an office visit, writes physician Ishani Ganguli.
Competitive / Operational Strategy · 38 signals · last 30 days -
Maryland sues UnitedHealth for $380M over Medicaid administration issues
Maryland Attorney General Anthony Brown has filed a lawsuit against UnitedHealth Group and Optum, seeking $380 million in damages stemming from alleged issues administering a Medicaid behavioral health program. “Marylanders in crisis and the providers who care for them rely on Maryland’s Medicaid program for essential mental health and substance abuse care. Optum provided a […] The post Maryland sues UnitedHealth for $380M over Medicaid administration issues appeared first on Becker's Payer I...
UnitedHealthcare · 34 signals · last 30 days -
Arkansas BCBS, CommonSpirit’s CHI St. Vincent near contract deadline
Arkansas Blue Cross and Blue Shield and Little Rock, Ark.-based CHI St. Vincent, under Chicago-based CommonSpirit Health, are nearing their Sept. 1 contracting deadline without an agreement. On Sept. 1, CHI St. Vincent — including its four hospitals, 80 medical clinics and more than 300 providers — could leave all provider networks for Arkansas BCBS […] The post Arkansas BCBS, CommonSpirit’s CHI St. Vincent near contract deadline appeared first on Becker's Payer Issues | Payer News .
Blue Cross Blue Shield plans · 20 signals · last 30 days -
The Villages Health reaches $541M False Claims Act settlement with DOJ
The Villages Health System has agreed to a $541.5 million settlement to resolve allegations that it submitted false diagnosis codes to secure higher payouts in Medicare Advantage.
Policy / Regulatory Changes · 67 signals · last 30 days -
Federal court rejects PhRMA challenge to Medicare drug price negotiation
A federal appeals court on Wednesday ruled against a lawsuit filed by representatives of the pharmaceutical industry challenging the federal Medicare drug price negotiation program, finding that drugmakers are not entitled to sell their products to Medicare at a price they would prefer. The U.S. Court of Appeals for the 5th Circuit affirmed a prior...
Competitive / Operational Strategy · 38 signals · last 30 days -
STAT+: CMS plans launch event for ACCESS, the Medicare chronic care pilot
In this edition of STAT Health Tech: CMS plans a launch event for Medicare chronic care pilot, and what the Meta settlement means for health AI.
Policy / Regulatory Changes · 67 signals · last 30 days -
Blue Shield of California names COO
Frank Caporusso will serve as COO of Blue Shield of California, effective Sept. 1. According to an Aug. 27 news release, the company reconfigured its COO role. Mr. Caporusso will lead enterprise-wide operations, collaborate with the executive leadership team on Blue Shield’s strategy and focus on the member and provider experience. He has been with […] The post Blue Shield of California names COO appeared first on Becker's Payer Issues | Payer News .
Blue Shield CaliforniaBlue Cross Blue Shield plans · 20 signals · last 30 days -
$10M from Florida’s Centene Medicaid settlement misappropriated by DeSantis administration: Report
A state grand jury determined that $10 million from a Centene Medicaid settlement was “misappropriated” under Florida Republican Gov. Ron DeSantis’ administration, according to a Jan. 28 sealed document obtained by CBS News Miami. Despite the findings, the document said the grand jury lacked evidence to bring criminal charges. The settlement stemmed from claims of […] The post $10M from Florida’s Centene Medicaid settlement misappropriated by DeSantis administration: Report appeared first on...
Centene FloridaCentene · 11 signals · last 30 days -
Optum Rx taps employer, government markets president
Mona Chitre, PharmD, will serve as the market president for the newly created employer and government markets segment under Optum Rx, UnitedHealth Group’s pharmacy benefit manager. Dr. Chitre will begin her role Aug. 31, according to an Aug. 26 LinkedIn post. She said the role unifies the commercial, health system, coalition, labor and trust, and […] The post Optum Rx taps employer, government markets president appeared first on Becker's Payer Issues | Payer News .
UnitedHealthOptumUnitedHealthcare · 34 signals · last 30 days -
Villages Health to pay $541.5M to settle Medicare Advantage fraud allegations
The Villages (Fla.) Health, a primary and specialty care provider group, has agreed to pay $541.5 million to resolve allegations that it violated the False Claims Act by submitting improper Medicare Advantage diagnosis codes, according to an Aug. 26 news release from the Justice Department. TVH, which sought Chapter 11 bankruptcy protection in July 2025 […] The post Villages Health to pay $541.5M to settle Medicare Advantage fraud allegations appeared first on Becker's Payer Issues | Payer Ne...
Policy / Regulatory Changes · 67 signals · last 30 days -
CMS releases fact sheet, FAQs on 340B claims data repository
The Centers for Medicare & Medicaid Services has released a fact sheet and FAQs on the 340B Part D claims data repository that will go live Oct. 1. Data submissions would currently be voluntary for 340B hospitals. However, the agency recently proposed to make data submissions mandatory starting in 2027. The fact sheet and FAQ provide an overview of the repository along with other key details.
Policy / Regulatory Changes · 67 signals · last 30 days -
Humana-owned Villages Health agrees to $542M settlement for overbilling Medicare
The Central Florida provider manufactured fake diagnosis codes for its Medicare Advantage patients from 2020 to 2024, the DOJ said. Humana bought The Villages Health last year.
Humana FloridaHumana · 13 signals · last 30 days -
Agency Information Collection Activities: Proposed Collection; Comment Request
The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information (including each proposed extension or reinstatement of an existing collection of information) and to allow 60 days for public comment on the proposed action. Int...
Policy / Regulatory Changes · 67 signals · last 30 days -
Cigna unveils new plan to bring together medical, supplemental benefits
Cigna is looking to better link medical and supplemental benefits for its members and has unveiled a new employer benefit that aims to further that goal.
CignaCigna · 10 signals · last 30 days -
Cigna to manage NFL’s behavioral health network
Cigna Healthcare will manage a new behavioral health network for eligible current and former National Football League (NFL) players and their eligible dependents beginning Sept. 1. The NFL and NFL Players Association (NFLPA) created the Behavioral Health Network as an enhancement to the NFL Player Insurance Plan, according to an Aug. 26 news release from NFLPA. Cigna […] The post Cigna to manage NFL’s behavioral health network appeared first on Becker's Payer Issues | Payer News .
CignaCigna · 10 signals · last 30 days -
GuideWell taps Cigna exec for CFO role
GuideWell, parent of Florida Blue, has named Brad Phillips as executive vice president and chief financial officer. “His leadership will help ensure GuideWell has the financial foundation to invest in better care, expand access, and be here for the people and communities we serve — not just today, but well into the future,” the company […] The post GuideWell taps Cigna exec for CFO role appeared first on Becker's Payer Issues | Payer News .
Cigna FloridaCigna · 10 signals · last 30 days -
Trump Administration Announces $3.15 Million to Expand Pharmacy Connectivity Throughout Rural Ohio Communities
Trump Administration Announces $3.15 Million to Expand Pharmacy Connectivity Throughout Rural Ohio Communities This federal investment will improve interoperability and management of patient healthcare coordination
Competitive / Operational Strategy · 38 signals · last 30 days -
On the fence about a statin? In borderline cases, calcium scans could be a tiebreaker
The increasingly popular coronary artery calcium scan is helpful in guiding statin use in only a small share of cases, new studies find.
SCANSCAN Health Plan · 11 signals · last 30 days -
Former Optum director sentenced to three years in prison for defrauding company
A former senior director of data analytics at Optum has been sentenced to three years in federal prison for creating a no-show job for a friend and pocketing kickbacks from their salary. Karan Gupta, 48, of Walnut Creek, Calif., was sentenced Aug. 24 by U.S. District Judge Kate Menendez in Minnesota, according to an Aug. […] The post Former Optum director sentenced to three years in prison for defrauding company appeared first on Becker's Payer Issues | Payer News .
Optum MinnesotaUnitedHealthcare · 34 signals · last 30 days -
Henry Ford Health Medicare Advantage membership surges 46%: 7 things to know
Detroit-based Henry Ford Health saw Medicare Advantage membership climb 45.8% year over year during the first half of 2026 as its insurance business helped drive revenue growth. Seven things to know: 1. Medicare Advantage membership reached 132,566 as of June 30, up from 90,935 at the same point in 2025, according to Henry Ford Health’s […] The post Henry Ford Health Medicare Advantage membership surges 46%: 7 things to know appeared first on Becker's Payer Issues | Payer News .
Membership Movement · 5 signals · last 30 days -
Monogram Health to pay $2.4M to settle Medicare Advantage upcoding allegations
The Justice Department told Healthcare Dive that Monogram, a home health company, overcharged Medicare through contracts with Cigna and Humana by inflating diagnostic codes.
HumanaCignaHumana + Cigna · 22 signals · last 30 days