Today's Top 20 Stories
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CMS: Insurers to lose $1.1B in risk adjustment payments from Bright Health, Friday exits
Bright Health and Friday Health Plans are unable to meet their risk-adjustment payment obligations, leaving other insurers $1.1 billion short, CMS disclosed Oct. 27. -
Private payer's prices highest in upper Midwest and Southeast, price transparency study finds
Payers' negotiated prices for office visits and medical services can vary widely from county to county, according to a price transparency study published Oct. 27 in JAMA Health Forum. -
Senators want to bust Medicare Advantage 'ghost' networks
Lawmakers are introducing a bill to crack down on inaccurate provider directories in Medicare Advantage.
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Medicaid in the headlines: 7 recent updates
Insurers appointed new executives to lead their Medicaid business, and one CEO expects Medicaid expansion is around the corner in more states. -
North Carolina treasurer urges state to drop weight loss drug coverage for employees
North Carolina's treasurer, Dale Folwell, is urging the board that oversees the state's employee health plan to end coverage for GLP-1 drugs such as Wegovy and Saxenda, citing high costs. -
Aetna plans another round of layoffs; 2023 cuts total 600
CVS Health is planning to lay off an additional 70 employees at Aetna, in addition to a previously announced round of layoffs. -
Jefferson Health adds new Medicare Advantage offerings for 2024
Jefferson Health Plan will add four new plans in 2024.
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Florida woman sentenced to 8 years in prison for $36M scheme to defraud Blue Cross Blue Shield
The lead defendant in a 15-defendant healthcare fraud scheme will serve over eight years in prison for conspiring to defraud Blue Cross Blue Shield. -
Lawmakers look to ease Medicaid churn
A group of U.S. senators and representatives are introducing legislation to provide Medicaid enrollees with a year of continuous coverage. -
Senators urge more action from CMS on misleading Medicare Advantage marketing
A group of senators says CMS actions to crack down on misleading marketing of Medicare Advantage plans do not go far enough. -
Cambia appoints former Optum exec to lead government business
Cambia Health Solutions has named William Krenz as senior vice president of government programs.
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Molina taps 2 execs to lead Medicaid business
Molina Healthcare is promoting two senior leaders to run its flagship Medicaid business, CEO Joe Zubretsky said on an Oct. 26 investor call. -
16% of adults considering dropping health insurance due to cost
Over half of U.S. adults say their healthcare costs are difficult to afford, including 43% of those with employer-sponsored insurance, a Commonwealth Fund survey published Oct. 26 found. -
Georgia seeks bidders for $6B Medicaid contracts
Georgia is seeking bids from payers to manage the state's Medicaid program. -
Former Medicare Advantage organization executive charged in multimillion dollar fraud scheme
A former executive of Elevance-owned HealthSun Health Plans has been charged for allegedly orchestrating a multimillion-dollar Medicare fraud scheme. -
BCBS companies ranked by medical loss ratios in first half of 2023
BCBS companies collectively reported an average medical loss ratio of 90.2% in the first half of 2023, according to an Oct. 24 report from Fitch Ratings shared with Becker's. -
BCBS Massachusetts exec appointed as New York's first customer experience officer
New York Gov. Kathy Hochul has appointed Tonya Webster to serve as the state's first chief customer experience officer. -
Why Humana is training every employee on health literacy
Kate Goodrich, MD, chief medical officer of Humana, is leading a companywide initiative to improve members' health literacy. -
Cigna sets quarterly dividend
The Cigna Group's board authorized the company to pay a cash dividend of $1.23 per share on Dec. 21 to all shareholders of record as of the close of business Dec. 6, according to an Oct. 25 Cigna news release. -
Judge upholds BCBS companies' antitrust settlement
A federal judge upheld a $2.7 billion settlement agreement resolving allegations Blue Cross Blue Shield Association members engaged in anti-competitive actions to drive up costs.
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