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Aetna has agreed to pay $117.7 million to resolve allegations that it violated the False Claims Act by submitting or…
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On March 8, a judge for the U.S. District Court in Connecticut approved a preliminary injunction against Aetna, ordering the insurer to alter its gender-affirming care policy for two plaintiffs. Several transgender women sued Aetna in 2024 over denied gender-affirming…
Anthem Blue Cross of California is bringing its controversial out-of-network penalty policy to California on June 1, a move that has already drawn legislative backlash in the insurer’s home state of Indiana. Under the policy, participating hospitals and facilities in…
Spartanburg (S.C.) Regional Healthcare System is slated to go out of network with Aetna commercial and Medicare Advantage plans April 15, according to the system’s website. The health system said its misalignment with the insurer stems from their Medicare contract,…
CMS issued requests for applications from Medicare Part D plans and state Medicaid agencies to join the voluntary “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth,” known as BALANCE, model. Under the model, CMS will negotiate with manufacturers on…
L.A Care Health Plan is the largest Medicaid managed care organization in the U.S. with nearly 2.4 million enrollees, according to KFF. KFF used CMS data reflecting enrollment totals as of July 1, 2024 across the 42 states and Washington,…
Point32Health is laying off approximately 100 employees, or 2.3% of its workforce. “We regularly review our organization to ensure our teams and department functions are optimally set up to deliver for our members and customers,” spokesperson for the company told…
Humana’s President and CEO Jim Rechtin was paid $18.8 million in total compensation in 2025, the insurer said in regulatory filings published March 6. CFO Celeste Mellet was the company’s highest-paid executive in 2025, earning $18.9 million in total compensation,…
Ten providers recently posted job listings seeking leaders in payer contracting and relations. Note: This is not an exhaustive list. Listings were compiled from job-seeker sites. 1. Albany (N.Y.) Medical Center seeks an assistance director of system payer contracting. 2.…
Across the country, 78% of states’ Medicaid beneficiaries, where applicable, were enrolled through a Medicaid managed care organization in 2024. KFF published the 2024 data showing percentages of the Medicaid population enrolled in managed care. KFF did not consider Idaho…
Washington state lawmakers pitched a bill in January that would prompt health insurance carriers on its benefit exchange to contribute to an abortion savings program. SB 6182 seeks to establish a fund to assist those who face barriers to abortion…
