Today's Top 20 Stories

  1. 11 top execs that have recently left Elevance Health

    Jakob Emerson -
    From the CFO of its government business division to the COO of Carelon, these are 11 executive departures from Elevance Health and its subsidiaries over the last year:

  2. Kentucky health system dropping UnitedHealth, Centene Medicare Advantage plans

    Jakob Emerson -
    Louisville, Ky.-based Baptist Health will be out of network with UnitedHealthcare and Centene's Wellcare Medicare Advantage plans, effective Jan. 1, 2024.

  3. The payer CEOs joining Taylor Swift, Oprah on Forbes' most powerful women list

    Rylee Wilson -
    Taylor Swift is the fifth-most powerful woman in the world, and CVS Health CEO Karen Lynch is the sixth, according to Forbes' ranking of the world's most powerful women. 

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  1. Proposed class action lawsuit filed to block BCBS Louisiana, Elevance deal

    Rylee Wilson -
    A Blue Cross and Blue Shield of Louisiana policyholder filed a proposed class action lawsuit seeking to block the insurer's sale to Elevance Health, nola.com reported Dec. 5. 

  2. California's Medicaid overhaul has mixed reception so far

    Rylee Wilson -
    California's Medicaid program overhaul is improving access to social services, but many health plans, nonprofit community organizations and other stakeholders say reimbursement rates are not covering the full cost of services. 

  3. Adventist, Blue Shield of California cut ties across 17 hospitals

    Jakob Emerson -
    Roseville, Calif.-based Adventist Health and Blue Shield of California have gone out of network across 17 hospitals.

  4. CMS to crack down on Medicaid redetermination compliance

    Rylee Wilson -
    CMS has laid out how it will sanction states that do not comply with Medicaid redetermination requirements. 

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  1. 15 top execs that have recently left UnitedHealth Group

    Jakob Emerson -
    From regional CEOs to its chief growth officer, these are 15 top executives that have recently departed from UnitedHealth Group and its subsidiaries.

  2. Presidential candidates are setting their sights on the ACA. Are voters?

    Rylee Wilson -
    The Affordable Care Act is back in the political spotlight, but few voters have the future of the law at the top of their lists of issues to address, according to a KFF poll published Dec. 1. 

  3. The 6 biggest payers with PBMs: Here's a rundown

    Paige Twenter -
    Here's how the six largest health insurance companies and their pharmacy benefit manager companies stack up. 

  4. States ramp up scrutiny of payers' AI use

    Jakob Emerson -
    States are ramping up scrutiny over how insurers across industries are deploying artificial intelligence for underwriting purposes, Bloomberg reported Nov. 30.

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  1. Providence Health Plan taps UnitedHealthcare VP as chief underwriter

    Jakob Emerson -
    Providence Health Plan has named Louis Flocco as its new chief of underwriting.

  2. 10 payers audited for Medicare Advantage overpayments in 2023

    Rylee Wilson -
    OIG audits found over $213 million in estimated Medicare Advantage overpayments in 2023. 

  3. Texas liquidates Bright Health

    Rylee Wilson -
    Texas has placed Bright Health's subsidiary in the state into receivership and ordered its assets liquidated, according to a court order issued Nov. 29. 

  4. Man sentenced to prison for $30M scheme that defrauded major payers

    Andrew Cass -
    A Tulsa, Okla., man was sentenced to 54 months in prison for a scheme that involved submitting more than $30 million in claims to major payers for COVID-19 testing services that were never performed. 

  5. Anthem BCBS Virginia, Aledade ink partnership

    Jakob Emerson -
    Anthem Blue Cross and Blue Shield in Virginia has partnered with value-based physician platform Aledade to expand access to primary care for more than 150,000 Medicaid beneficiaries across Virginia.

  6. Arizona awards long-term managed care contracts to UnitedHealth, Centene

    Jakob Emerson -
    Arizona has awarded long-term managed care contracts to Centene and UnitedHealthcare.

  7. Medicare Advantage in the headlines: 8 recent updates

    Rylee Wilson -
    Cigna's Medicare Advantage business may have a potential buyer, and Washington is ramping up scrutiny on prior authorization and transparency in the program. 

  8. Medicare Advantage changes 'incredibly positive,' UnitedHealth CEO says

    Rylee Wilson -
    Medicare Advantage rate changes will have a ripple effect through UnitedHealth Group's business in 2024, but its leaders have a sunny outlook despite lower projected growth. 

  9. UnitedHealthcare, Baptist Health near split date

    Andrew Cass -
    Little Rock, Ark.-based Baptist Health could go out of network with UnitedHealthcare Medicare Advantage plans if the sides are unable to reach an agreement by Dec. 31, Arkansas Money & Politics reported Nov. 30.

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