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Medicare Payment Advisory Commission insights, Congressional reports and enrollment data have all been released in the early months of 2026.…
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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 failing to withdraw inaccurate diagnosis codes for its Medicare Advantage enrollees in order to increase payments from CMS. The settlement…
Gov. Tim Walz unveiled a proposal March 10 to eliminate managed care organizations from the state’s Medicaid program and replace them with a single statewide organization. Currently, about 45% of the state’s Medicaid spending and nearly 80% of basic care…
Elevance said it was “surprised and disappointed” by a recent CMS sanction threat, which would suspend enrollment in Medicare Advantage prescription drug plans, CFO Mark Kaye said March 10 at the Barclays 28th Annual Global Healthcare Conference in Miami. The…
Centene expects its ACA membership to fall nearly 40% by the end of 2026, company executives said March 11 at the Barclays 28th Annual Global Healthcare Conference. CEO Sarah London said the company ended 2025 with 5.5 million members in…
UnitedHealthcare and AARP are facing a lawsuit regarding alleged Medicare supplement denials, according to a Feb. 22 complaint filed with the U.S. District Court for New Jersey. The organizations collaborate on a handful of AARP-branded insurance products, including Medigap plans.…
The Iowa House passed legislation on Feb. 25 that would ban health insurers from denying coverage for a service solely because the referring primary care provider is out of network. Under the legislation, insurers would also be barred from imposing…
The Office of the Inspector General for HHS found 121,454 emergency department procedures were possibly billed incorrectly in 2021 and 2022, leading to over $15.1 million in improper or potentially improper payments. Medicare improperly paid physicians $922,524 and may have…
Payers are continuing to trim their workforces amid financial pressures, growing medical and pharmacy utilization, Medicaid funding cuts and strategic restructuring. Below are workforce reduction efforts or job eliminations that were announced or take effect in 2026. Insurance industry layoffs…
The Congressional Joint Economic Committee identified an additional $13.4 billion contributing to higher Medicare Part B premiums in 2025 due to Medicare Advantage overpayments, according to a March 10 report. The committee relied on Medicare Payment Advisory Commission estimates. Overpayments…
The possibility of a state-based health insurance exchange in Mississippi is looking less probable, state Insurance Commissioner Mike Chaney told Mississippi Today in a March 10 report. “It might be too little, too late, because the dollars are not there…
