Signal Timeline
Related signals plotted on one shared timeline — one topic-colored bubble row apiece.
209 signals in the last 30 days
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Showing the 100 most recent of 209 — see the Feed for the full archive.
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A tale of 2 retailers: What drives success for co-branded Medicare Advantage plans
In August, SCAN Health Plan announced a partnership with Costco Wholesale Corp. to sell insurance products for older adults. Sound familiar? Costco is not the first retailer to partner with a Medicare Advantage insurer. Kroger has worked with Select Health and Priority Health on co-branded MA plans in 2023 and 2024. Websites outlining Select Health […] The post A tale of 2 retailers: What drives success for co-branded Medicare Advantage plans appeared first on Becker's Payer Issues | Payer Ne...
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Trump Administration Announces $76 Million to Strengthen Regional Coordination and Modernize Healthcare Technology for New York
Trump Administration Announces $76 Million to Strengthen Regional Coordination and Modernize Healthcare Technology for New York This federal investment will strengthen regional partnerships, improve coordination of care, and expand access to healthcare services for rural New Yorkers
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Trump Administration Announces $5.48 Million to Strengthen Healthcare Workforce Pipeline in Rural Rhode Island
Trump Administration Announces $5.48 Million to Strengthen Healthcare Workforce Pipeline in Rural Rhode Island This federal investment will expand career and technical education in Rhode Island to help train the next generation of healthcare professionals
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Trump Administration Invests $25 Million to Modernize Healthcare Technology, Expand Telehealth, and Improve High-Speed Internet Connectivity Across Michigan
Trump Administration Invests $25 Million to Modernize Healthcare Technology, Expand Telehealth, and Improve High-Speed Internet Connectivity Across Michigan This federal investment will help expand access and upgrade technology so doctors and patients can better connect and coordinate care across Michigan
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STAT+: Top Boston hospitals clash over Medicare Advantage network after split
First, Mass General Brigham split with Dana-Farber. Now its Medicare Advantage plan is dropping the cancer hospital.
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8 recent Medicare Advantage contract suspensions, terminations
CMS has taken a series of enforcement actions against Medicare Advantage plans over the last two years, suspending enrollment and terminating contracts over issues ranging from network adequacy to financial solvency failures. Eight updates: The post 8 recent Medicare Advantage contract suspensions, terminations appeared first on Becker's Payer Issues | Payer News .
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Medicare paid estimated $380M for unused organs: OIG
Over a six-year period, Medicare may have spent $380 million on organs that were not ultimately used in covered enrollee transplants, according to a September HHS Office of Inspector General report. Under federal law, Medicare can only reimburse certified transplant centers for organs used in covered transplants. However, CMS guidance relies on the assumption that […] The post Medicare paid estimated $380M for unused organs: OIG appeared first on Becker's Payer Issues | Payer News .
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Democrats in talks about expanding Medicare, breaking up large insurers: Report
House Democrats are discussing a healthcare policy agenda that could include an expansion of the Medicare program, the Washington Post reported Sept. 3. House Minority Leader Hakeem Jeffries told NBC News that reversing the Medicaid cuts under H.R.1 and reviving enhanced ACA premium tax credits have “uniform Democratic support” ahead of the midterms. But privately, […] The post Democrats in talks about expanding Medicare, breaking up large insurers: Report appeared first on Becker's Payer Iss...
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CMS rebrands ICHRA
CMS has rebranded individual coverage health reimbursement arrangements to CHOICE Arrangements, or Custom Health Option and Individual Care Expense. The new name for the alternative health insurance model was announced Sept. 3 by CMS Administrator Mehmet Oz, MD, at an event in Indiana. ICHRAs let employers give workers a fixed, tax-free amount to buy their […] The post CMS rebrands ICHRA appeared first on Becker's Payer Issues | Payer News .
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OIG: Medicare Part D plans spent millions on ineligible OTC drugs
Medicare Part D plans made millions in payments for drugs that were ineligible under the program, according to a new federal audit.
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CareFirst BCBS files trademark infringement complaint
CareFirst BlueCross BlueShield filed a trademark infringement lawsuit against a Hagerstown, Md.-based in-home healthcare and staffing company Aug. 27. The complaint, filed in the U.S. District Court for Maryland, said the insurer has more than 25 registrations issued by the U.S. Patent and Trademark Office for its “CAREFIRST” mark. The filing said the insurer has […] The post CareFirst BCBS files trademark infringement complaint appeared first on Becker's Payer Issues | Payer News .
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450+ Cigna employees sign petition following end to GLP-1 coverage
More than 450 Cigna employees have signed a petition challenging the company’s decision to end GLP-1 weight-loss coverage for its workforce. Cigna stopped covering GLP-1s for weight loss through its employee health plan July 1. The company still covers the drugs for diabetes. In the wake of the decision, hundreds of Cigna employees detailed their […] The post 450+ Cigna employees sign petition following end to GLP-1 coverage appeared first on Becker's Payer Issues | Payer News .
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Medicare Advantage Spending Comparisons Miss Key Costs and Benefits for Seniors, New Analysis Finds
BMA-commissioned analysis identifies gaps in MedPAC methodology as Commission convenes September meeting WASHINGTON —As the Medicare Payment Advisory Commission (MedPAC) convenes its September meeting, Better Medicare Alliance today released a … Continue reading "Medicare Advantage Spending Comparisons Miss Key Costs and Benefits for Seniors, New Analysis Finds" The post Medicare Advantage Spending Comparisons Miss Key Costs and Benefits for Seniors, New Analysis Finds appeared first on Bette...
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Federal watchdog claims Medicare Part D sponsors paid $587.7M for over-the-counter drugs mislabeled as prescription-only
Medicare Part D sponsors paid pharmacies $587.7 million for some over-the-counter drugs with obsolete prescription-only labels, despite CMS oversight. Medicare Part D does not cover OTC drugs. According to an Aug. 31 HHS Office of Inspector General report, Part D sponsors made “ineligible” payments for five drugs — more than one year after the brand-name […] The post Federal watchdog claims Medicare Part D sponsors paid $587.7M for over-the-counter drugs mislabeled as prescription-only appear...
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Centene’s Health Net to exit commercial group market in California, Oregon
Centene subsidiary Health Net is pulling out of the commercial employer group market in California and Oregon, the company confirmed to Becker’s. “Health Net has made the decision to exit the traditional commercial group business in California and Oregon in order to focus on government sponsored healthcare,” a spokesperson for the insurer said in a […] The post Centene’s Health Net to exit commercial group market in California, Oregon appeared first on Becker's Payer Issues | Payer News .
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Oncology company Thyme Care raises $125M, backed by Morgan Health, Humana and CVS Health Ventures
Thyme Care landed a series E financing round of more than $125 million backed by strategic payers and providers as it aims to expand beyond cancer care navigation.
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Scan.com raises $220M to expand US medical imaging network
The company plans to use the funding to further expand its U.S. network of imaging providers, as well as invest in its API and agentic AI infrastructure.
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Site-neutral imaging payments could save $9.7B across Medicare, commercial markets: BCBS Association
Enacting site-neutral payments under Medicare for imaging services would generate an estimated $9.7 billion in combined savings over 10 years, according to a new analysis commissioned by the Blue Cross Blue Shield Association. The report, prepared by external consulting groups and published Aug. 24, quantifies both the Medicare impact and the spillover effects on commercial […] The post Site-neutral imaging payments could save $9.7B across Medicare, commercial markets: BCBS Association appear...
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IBX expands subsidized degree opportunities for employees
Independence Blue Cross is expanding its professional development opportunities for employees through a new partnership with Reading, Pa.-based Alvernia University. According to a Sept. 1 news release, the IBX University Partnership Deferral Program allows eligible employees to pursue undergraduate and graduate degrees with tuition support: an annual allowance of $5,250. Payments are deferred until an […] The post IBX expands subsidized degree opportunities for employees appeared first on Bec...
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Humana sets quarterly dividend
Humana’s board of directors declared a $0.885 per share dividend to be paid Nov. 27. The dividend will be paid to all shareholders of record as of the close of business Oct. 30, according to a Sept. 2 Humana news release. The company reported a $694 million profit for the second quarter, up more than […] The post Humana sets quarterly dividend appeared first on Becker's Payer Issues | Payer News .
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Elevance’s Wellpoint taps COO for Tennessee
Kraig Dalton has joined Elevance Health’s Wellpoint as COO of its Tennessee health plan. “Supporting Tennesseans in need is deeply important to me, and I’m honored to take on this role leading operations at Wellpoint,” Mr. Dalton said in an August LinkedIn post. Mr. Dalton was most recently a director at Findhelp, a social care […] The post Elevance’s Wellpoint taps COO for Tennessee appeared first on Becker's Payer Issues | Payer News .
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Louisiana’s Medicaid contract with Elevance-BCBS venture to end, affecting 290,000
The Louisiana Department of Health’s Medicaid managed care contract with Healthy Blue, formed as a joint venture between Blue Cross and Blue Shield of Louisiana and Elevance Health, will end Dec. 31. More than 290,000 Medicaid members currently have Healthy Blue, according to a Sept. 1 news release from the department. While Medicaid eligibility does […] The post Louisiana’s Medicaid contract with Elevance-BCBS venture to end, affecting 290,000 appeared first on Becker's Payer Issues | Payer...
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Medicare spent hundreds of millions of dollars on ineligible drugs, audit finds
Shoddy CMS oversight is to blame, and the agency needs to do better, the HHS Office of the Inspector General said. The CMS concurred.
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UnitedHealthcare cuts prior authorization from 1,700 codes
The list tells providers what treatments will no longer need preapproval this October, part of UnitedHealthcare’s pledge to cull 30% of its much-maligned utilization management controls. The codes span a broad range of services.
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UnitedHealthcare to nix prior auth on 1,700 services on Oct. 1
UnitedHealthcare said earlier this year that it was aiming to eliminate 30% of prior authorization requirements by the end of 2026.
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Louisiana’s Medicaid program will lose another provider, affecting 290,000 people
The Healthy Blue plan, offered by Elevance Health and Blue Cross Blue Shield of Louisiana, will no longer be available to Medicaid recipients in 2027.
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CHI St. Vincent no longer part of Blue Cross Blue Shield of Arkansas network
CHI St. Vincent will not be part of the Blue Cross Blue Shield of Arkansas network after the Little Rock-based hospital system and the insurer failed to reach an agreement on renewing their contract, both sides announced Tuesday. The two failed to reach an agreement during negotiations over the past several months about how much […]
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Ohio Chamber sues UnitedHealthcare over alleged effort to poach members
The Ohio Chamber of Commerce is suing UnitedHealthcare over allegations the insurer withheld data and used confidential information obtained as the administrator of the chamber’s health benefits program to steer small businesses into its own plans. Hours after the lawsuit was filed Sept. 1 in an Ohio federal court, U.S. District Judge Algenon Marbley temporarily […] The post Ohio Chamber sues UnitedHealthcare over alleged effort to poach members appeared first on Becker's Payer Issues | Payer...
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Hospital groups rail against CMS' proposed 340B changes, site-neutral payments
Public comments for the latest OPPS proposed rule saw several major hospital groups all but threatening a court showdown over CMS' planned policy changes.
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6 payer reimbursement changes to know in September
Several of the nation’s largest health insurers rolled out reimbursement policy changes Sept. 1, ranging from new lab testing coverage limits at UnitedHealthcare to a billing overhaul at Blue Cross Blue Shield of Michigan that has drawn pushback from providers. Six payer reimbursement changes to know: 1. UnitedHealthcare UnitedHealthcare is tightening reimbursement for lab tests […] The post 6 payer reimbursement changes to know in September appeared first on Becker's Payer Issues | Payer News .
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Johns Hopkins Health Plans names interim CEO
Daniel Chojnowski will serve as the interim CEO for Johns Hopkins Health Plans. According to a Sept. 1 LinkedIn post from the insurer, Mr. Chojnowski has served as CFO for the past seven years. He previously held financial leadership roles at Portland, Maine-based Martin’s Point Health Care, his LinkedIn profile said. In August, Humana tapped […] The post Johns Hopkins Health Plans names interim CEO appeared first on Becker's Payer Issues | Payer News .
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UnitedHealthcare to participate in Mississippi’s short-term plans push
Mississippi Insurance Commissioner Mike Chaney confirmed UnitedHealthcare will offer short-term, limited-duration insurance through the Mississippi Comprehensive Health Insurance Risk Pool Association, with a projected start date in 2027. The short-term plans will run for a maximum of 364 days, Mr. Chaney told Becker’s. These plans are not ACA compliant, meaning they do not offer the […] The post UnitedHealthcare to participate in Mississippi’s short-term plans push appeared first on Becker's...
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Head of UnitedHealthcare’s Illinois market to oversee Wisconsin, Michigan
The head of UnitedHealthcare’s Illinois plan will now oversee Wisconsin and Michigan.
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Trump Administration Announces $58 million to Deliver New Ambulances and Upgrade Emergency Communications Systems Across Hawaii
Trump Administration Announces $58 million to Deliver New Ambulances and Upgrade Emergency Communications Systems Across Hawaii This federal investment will help expand access, strengthen the health workforce, improve infrastructure, and advance technology for rural communities across Hawaii
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UnitedHealthcare to drop prior authorization requirements for 1,700 services
UnitedHealthcare has released the specific procedure codes it will exempt from prior authorization as part of the insurer’s previous pledge to reduce requirements by 30% before the end of 2026. The code lists cover 1,700 procedure codes for a range of services across commercial, Medicare Advantage, individual exchange, and Medicaid plans. Effective Oct. 1, providers […] The post UnitedHealthcare to drop prior authorization requirements for 1,700 services appeared first on Becker's Payer Issue...
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Medicare Advantage disenrollment jumps with each complex diagnosis: Study
Each complex condition further drives Medicare Advantage disenrollment, according to research published Aug. 21 in JAMA Health Forum. Researchers from Baltimore-based Johns Hopkins University reviewed a cohort of more than 1 million MA beneficiaries to determine transitions to traditional Medicare or other MA plans. Here are six notes from the research: The post Medicare Advantage disenrollment jumps with each complex diagnosis: Study appeared first on Becker's Payer Issues | Payer News .
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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...
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United States v. Anthem, Inc.
Case 1:20-cv-02593-ALC-KHP Document571_ Filed 09/01/26 Page1of9 U.S. Department of Justice United States Attorney Southern District of New York 86 Chambers Street New York, New York 10007 September 1, 2026 Via ECF The Honorable Katharine H. Parker United States District Court 500 Pearl Street New York, New York 10007 Re: = United States of America v. Anthem, Inc., No. 20 Civ. 2593 (ALC) (KHP) Dear Judge Parker: This Office represents the Government in the above-referenced matter. We write Ori...
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PUBLIC COMMENT — Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems, etc, CMS-1850-P, RIN 0938-AV83
The post PUBLIC COMMENT — Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems, etc, CMS-1850-P, RIN 0938-AV83 appeared first on Paragon Health Institute .
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In next phase of sustainability, UCI Health, Kaiser Permanente, and others turn to electric hospitals
The U.S. healthcare sector is responsible for about 9% of the country’s greenhouse gas emissions. A growing number of providers have implemented sustainability agendas, with electrification being the next frontier.
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STAT+: GLP-1 drugs are almost single-handedly forcing employers to reconsider workers’ health care
Another hospital system sues CVS Health, how Medicaid cuts will change everything, and more
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DOJ steps up crackdown on Medicare Advantage upcoding
The Justice Department’s scrutiny of Medicare Advantage risk adjustment is intensifying, with two recent settlements totaling nearly $1.1 billion highlighting federal concerns about diagnosis coding practices that can increase payments to health plans. The latest came Aug. 27, when The Villages (Fla.) Health System agreed to pay $541.5 million to resolve allegations that it violated […] The post DOJ steps up crackdown on Medicare Advantage upcoding appeared first on Becker's Payer Issues | Pa...
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UnitedHealthcare taps CEO for Washington state Medicaid plan
UnitedHealthcare Community Plan of Washington has named Scott Williams as CEO. According to an August LinkedIn post, Mr. Williams will work with members, providers, community groups, tribes and state leaders in his role with the Medicaid managed care plan. Prior to this position, Mr. Williams was a vice president of network contracting with UnitedHealth Group. […] The post UnitedHealthcare taps CEO for Washington state Medicaid plan appeared first on Becker's Payer Issues | Payer News .
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Centene names new CIO
Centene has named Bradley Bolivar as its new chief information officer, effective Aug. 31. Mr. Bolivar previously served as CIO at Fannie Mae, where he led enterprise technology strategy across application development, infrastructure, cybersecurity, data, artificial intelligence and workplace technology. He has also held leadership roles at Warner Bros. Entertainment. He succeeds Brian LeClaire, who […] The post Centene names new CIO appeared first on Becker's Payer Issues | Payer News .
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Centene taps Fannie Mae executive as CIO
Bradley Bolivar is taking the reins of Centene’s IT strategy as artificial intelligence drives a sea change for how insurers do business.
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Maryland sues Optum over 'defective' computer system
Maryland has filed a lawsuit against UnitedHealth Group, alleging that its Optum unit defrauded the state's Medicaid program by providing a faulty computer system.
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Trump admin blocks over $1.6B in potentially fraudulent Medicare lab payments: CMS
The CMS Fraud Defense Operations Center has also accounted for more than $371 million in Medicare suspended payments involving 267 providers and suppliers since Jan. 1, the agency said.
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CMS Prevents $1.6 Billion in Fraudulent Medicare Laboratory Payments
CMS Prevents $1.6 Billion in Fraudulent Medicare Laboratory Payments 157 fraudulent lab providers revoked from Medicare program Centers for Medicare & Medicaid Services (CMS) enforcement actions have stopped more than $1.6 billion in potentially improper Medicare laboratory payments since the start of the Trump Administration – further evidence that CMS’ efforts to crush fraud are working to protect taxpayer dollars and improve Medicare program integrity. This includes $732 million in savings...
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CMS touts blocking $1.6B in potentially fraudulent Medicare payments
CMS said its enforcement efforts have resulted in blocking more than $1.6 billion in possibly improper Medicare lab payments throughout President Trump’s administration. An Aug. 28 CMS news release said these enforcement actions included savings of $732 million from 157 providers with revoked Medicare privileges, and a CMS investigation of 600 labs that resulted in 185 payment […] The post CMS touts blocking $1.6B in potentially fraudulent Medicare payments appeared first on Becker's Payer Is...
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Massachusetts Medicare Advantage insurer hit with enrollment freeze again
CMS has again suspended enrollment for two Medicare Advantage prescription drug plans offered by Boston-based EternalHealth, the second time in less than two years that the insurer has faced sanctions. The agency said Aug. 27 the enrollment freeze on the two plans is based on its determination that EternalHealth’s conduct “poses a serious threat to […] The post Massachusetts Medicare Advantage insurer hit with enrollment freeze again appeared first on Becker's Payer Issues | Payer News .
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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...
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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 .
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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...
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‘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...
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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.
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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...
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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 .
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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.
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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...
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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.
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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 .
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$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...
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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 .
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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...
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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.
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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.
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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...
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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.
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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 .
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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 .
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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
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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.
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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 .
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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 .
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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.
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Her Breast MRI Was Approved, But That Didn’t Mean Her Insurance Would Pay
Stephanie Halver’s doctor recommended she get a breast MRI, partly because of her family’s cancer history. Her insurer approved the scan, but unlike mammograms, breast MRIs aren’t universally covered as zero-cost preventive care.
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Elevance Health to pay $15M to settle nurse overtime lawsuits
A federal judge has given final approval to a $14.75 million settlement between Elevance Health and a group of nurses who alleged the insurer misclassified them as exempt from overtime pay. U.S. District Judge David Novak signed off on the deal Aug. 20 in the Eastern District of Virginia, closing out five related lawsuits that […] The post Elevance Health to pay $15M to settle nurse overtime lawsuits appeared first on Becker's Payer Issues | Payer News .
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Health plan underwriting losses balloon to $10.4B: Report
Health insurers collectively lost $10.4 billion on underwriting in 2025, a dramatic deterioration from $1.7 billion the year before, according to a Mark Farrah Associates analysis. The Aug. 25 analysis compared 2024 and 2025 profitability across four segments: individual, employer-group, Medicare Advantage and managed Medicaid. The analysis is based on aggregated NAIC financial filings and […] The post Health plan underwriting losses balloon to $10.4B: Report appeared first on Becker's Payer...
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Trump Administration Announces $160 Million to Bring Cutting-Edge Technology, Drones Prescription Deliveries, Surgical Robotics and More to Alaska
Trump Administration Announces $160 Million to Bring Cutting-Edge Technology, Drones Prescription Deliveries, Surgical Robotics and More to Alaska This federal investment will help expand access, strengthen the health workforce, improve infrastructure, and advance technology for communities across Alaska
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High medical costs continue to hang over insurers’ margin recovery: Moody’s
Most large health insurers posted stronger-than-expected earnings in the second quarter, but much of the improvement might not be durable, according to a Moody’s Ratings analysis published Aug. 24. Average EBITDA margins across the seven largest publicly traded insurers rose to 4.7% in Q2, up from 3.9% in the same period a year earlier. UnitedHealth […] The post High medical costs continue to hang over insurers’ margin recovery: Moody’s appeared first on Becker's Payer Issues | Payer News .
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Medicare Advantage provider agrees to $2.4M false claims settlement
Tennessee-based in-home care provider Monogram Health has agreed to pay $2.4 million to settle allegations that it caused the submission of false diagnosis codes to boost Medicare Advantage payments. From Jan. 1, 2021, through Dec. 31, 2023, Monogram allegedly knowingly submitted diagnosis codes that were not clinically accurate, not supported by patients’ medical records, or […] The post Medicare Advantage provider agrees to $2.4M false claims settlement appeared first on Becker's Payer Issu...
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Elevance’s behavioral health division nabs new president
Dr. Patrick Fox, a forensic psychiatrist and health plan leader, will take the reins at Carelon Behavioral Services effective immediately. His experience will be “invaluable” for the unit, a top Elevance executive said.
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Wellpoint New Jersey, Carelon Behavioral Health get new presidents in Elevance leadership swap
Elevance Health announced two leadership changes Aug. 24, swapping the president of its New Jersey health plan into the top role at its behavioral health division and installing a longtime government affairs executive in his place. Patrick Fox, MD, has been named president of Carelon Behavioral Health, effective immediately, after previously serving as president of […] The post Wellpoint New Jersey, Carelon Behavioral Health get new presidents in Elevance leadership swap appeared first on Bec...
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Highmark taps Aetna exec to lead insurance business
Highmark has named Gustavo (Gus) Giraldo as president of its health insurance division, effective immediately. Mr. Giraldo most recently served as senior vice president of individual and family plans at Aetna, and he’s previously held executive leadership roles at Magellan Health and Cigna Healthcare. He succeeds Tom Doran, who is departing the organization to pursue […] The post Highmark taps Aetna exec to lead insurance business appeared first on Becker's Payer Issues | Payer News .
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Highmark Health’s insurance unit powers first-half turnaround
The subsidiary reworked its Medicare Advantage benefit offerings and directed members toward lower-cost care sites.
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BCBS Kansas City exec named CFO at NAIC
The National Association of Insurance Commissioners has named Jeff Ahlers as CFO. Mr. Ahlers was previously vice president of finance and corporate controller at Blue Cross and Blue Shield of Kansas City. The National Association of Insurance Commissioners develops model laws and guidelines that states can adopt to govern insurance markets and is made up […] The post BCBS Kansas City exec named CFO at NAIC appeared first on Becker's Payer Issues | Payer News .
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Oregon to launch state-based ACA exchange
Oregon has received approval from CMS to launch a state-run ACA marketplace starting Nov. 1. The new platform, Explore Health, will let Oregon residents shop for ACA plans, check subsidy eligibility and enroll in coverage directly through the state rather than the federal exchange. The Oregon legislature authorized the transition in 2023 through Senate Bill […] The post Oregon to launch state-based ACA exchange appeared first on Becker's Payer Issues | Payer News .
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Oz says MMR vaccine 'is not a lethal vaccine'
Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services (CMS), noted Sunday the measles, mumps and rubella (MMR) vaccine is not lethal, contradicting President Trump. “The MMR vaccine is not a lethal vaccine, and it is offered in other countries,” Oz told host Margaret Brennan on CBS News’s “Face the Nation.”...
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A look inside the expanded partnership between SCAN and Costco
SCAN Group and retailer Costco are expanding their partnership with the launch of new cobranded Medicare products.
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Cigna named in addiction treatment providers’ lawsuit claiming $12.8M underpayment
Ten California addiction providers filed a lawsuit against Cigna on Aug. 19, claiming the insurer shortchanged them by $12.8 million. The lawsuit spans March 1, 2022, through March 15, 2026. Before 2015, Cigna would pay billed charges in full or at a “reasonable and customary” rate but eventually changed that policy, according to the complaint, […] The post Cigna named in addiction treatment providers’ lawsuit claiming $12.8M underpayment appeared first on Becker's Payer Issues | Payer News .
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Blue Cross and Blue Shield of Illinois marks two years of progress through expanded special beginnings program
Blue Cross and Blue Shield of Illinois announced the second anniversary of its expanded Special Beginnings® Maternal and Infant Health Initiative, highlighting investments and partnerships supporting healthier outcomes for moms […]
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The MolinaCares Accord Grants $100,000 to Illinois Public Health Association to Support Illinois’ Medicaid Population
The MolinaCares Accord (“MolinaCares”), in collaboration with Molina Healthcare of Illinois (“Molina”), announced a $100,000 grant to support the Illinois Public Health Association’s (“IPHA”) new community health worker (“CHW”) pilot program that aims to reduce procedural Medicaid disenrollment during redetermination – the annual Medicaid renewal process.
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Aetna to cut Medicare Advantage broker commissions again
Aetna will stop paying broker commissions on certain Medicare Advantage plans beginning Sept. 15, the company confirmed to Becker’s. “Aetna routinely reviews and updates our distribution strategy, including the commissionable status of our plan offerings,” an Aetna spokesperson said. “As a result, we have made a business decision to change certain plans to non-commissionable starting […] The post Aetna to cut Medicare Advantage broker commissions again appeared first on Becker's Payer Issues...
Aetna -
Cityblock Health acquires rural Medicare provider Homeward Health
Cityblock Health has signed a definitive agreement to acquire Homeward Health, a rural-focused Medicare Advantage provider, in an all-stock transaction. The combination pairs Cityblock’s urban Medicaid and dual-eligible care model with Homeward’s rural-first approach, Cityblock CEO and co-founder Toyin Ajayi, MD, said in an Aug. 21 note published on the company’s website. Homeward serves nearly […] The post Cityblock Health acquires rural Medicare provider Homeward Health appeared first on Be...
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Mental health workers say algorithmic triage is hurting patients
When Kaiser Permanente triage clinician Harimandir Khalsa began working in the psychiatry department at Kaiser’s Walnut Creek Medical Center in Northern California, she was on a team of nine people. Today, just over three years later, she is one of only three triage clinicians left. Some of the work once handled by employees has shifted […]
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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...
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UnitedHealthcare expands behavioral coaching program for youths
UnitedHealthcare is expanding access to its child and family behavioral coaching program, making it available to 13 million commercial members.
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‘We’re in wartime’: As major insurers continue pulling back on Medicare Advantage, SCAN places another contrarian bet
As insurers nationwide prepare to take their latest Medicare products to market this fall, SCAN Group is doubling down on an unconventional growth strategy meant to grab the attention of seniors and healthcare leaders alike. “You can’t solve a problem until you actually acknowledge you have a problem,” SCAN President and CEO Sachin Jain, MD, […] The post ‘We’re in wartime’: As major insurers continue pulling back on Medicare Advantage, SCAN places another contrarian bet appeared first on Beck...
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Senate Democrats call on feds to halt Medicaid data sharing with ICE
Senate Democrats on Aug. 17 called on federal officials to end Medicaid enrollee data sharing with the Department of Homeland Security and Immigration and Customs Enforcement. Sens. Ron Wyden, D-Ore., Jeff Merkley, D-Ore., Edward Markey, D-Mass., Cory Booker, D-N.J., and Chris Van Hollen, D-Md., sent two letters, one to CMS and HHS and another to […] The post Senate Democrats call on feds to halt Medicaid data sharing with ICE appeared first on Becker's Payer Issues | Payer News .
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Trump Administration Delivers Critical Funding to Launch the Coordinating and Connecting Care Initiative in North Dakota
Trump Administration Delivers Critical Funding to Launch the Coordinating and Connecting Care Initiative in North Dakota This federal investment will help bring high-quality care closer to home by improving coordination for rural North Dakotans