Today's Top 20 Stories
  1. Bright Health to lay off 68 employees at Minnesota headquarters

    Bright Health is implementing another round of layoffs, the Minneapolis/St. Paul Business Journal reported Feb. 1. 
  2. AmeriHealth Caritas taps Georgia market president

    AmeriHealth Caritas has named Marla Purvis as Georgia market president. 
  3. New CMS Medicare Advantage audit rule lacks information, Humana execs say

    CMS' new Medicare Advantage auditing standards did not include enough information about auditing methods to understand its full impacts, Humana executives said on a Feb. 1 investor call. 

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  1. How Health Net is making sure members know about Medicaid redeterminations

    Health Net is launching a "review to renew" campaign to inform its millions of Medicaid members in California about upcoming redeterminations. 
  2. Where government insurance enrollment stands in 2023

    CMS released 2023 enrollment figures for government-sponsored health plans Jan. 31.
  3. UnitedHealthcare overpayment, appeal letters going paperless in 13 states

    UnitedHealthcare will stop mailing overpayment and appeal decision letters to primary and ancillary healthcare providers in 13 states and Washington, D.C., starting May 5. 
  4. GuideWell's PopHealthCare names CIO

    GuideWell subsidiary PopHealthCare has named Kevin Hiler as chief information officer.

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  1. Maine's ACA exchange director to lead new healthcare affordability office

    Maine Gov. Janet Mills has nominated the state's ACA marketplace director, Meg Garratt-Reed, to be executive director of the new Office of Affordable Health Care. 
  2. 2,000 BCBS Michigan beneficiaries may have another member's bill

    About 2,000 Blue Cross Blue Shield of Michigan beneficiaries may have someone else's January premium bill, NBC affiliate WDIV reported Jan. 31. 
  3. 23 payer exec moves in January

    From several new CEOs and presidents to a new chief innovation officer at UnitedHealth Group, these are executive moves at 23 different payers reported by Becker's since Jan. 1: 
  4. Centene to pay Indiana $66M in latest overbilling settlement

    Centene has agreed to pay Indiana more than $66 million to settle allegations it overbilled the state's Medicaid program for pharmaceutical services. 

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  1. Humana posts $15M Q4 loss, names top execs

    Humana posted revenues of nearly $93 billion in 2022 and a net loss of $15 million in the most recent quarter, according to its year-end earnings report published Feb. 1. 
  2. 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, Seeking Alpha reported Jan. 31, citing a CTFN report. 
  3. 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 benchmark to drive further progress, Andrea Willis, MD, chief medical officer for BCBS Tennessee, said in the Tennessean Jan. 26. 
  4. Medicare Advantage in the headlines: 7 recent updates

    Medicare Advantage plans will face tougher auditing standards after a highly-anticipated ruling from CMS. The program also hit 30 million members in recent weeks, and payers are expecting enrollment numbers to keep climbing. 
  5. 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 costs the healthcare system billions of dollars every year and raises costs on health plan members. 
  6. 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 insurers from using "Medicare" in plan titles or advertisements and impose "significant fines for any insurer that engages in this deceptive practice."
  7. 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 in-network mental healthcare providers. 
  8. 7 reactions to CMS' Medicare Advantage audit ruling

    Organizations representing payers say tougher auditing standards CMS will impose on Medicare Advantage plans could create higher premiums and fail to target fraud. Others say the new rule, which eliminates the fee-for-service adjuster, doesn't go far enough. 
  9. 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 and Medicaid director depart. 

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