Author: Andrew Cass

Regence BlueCross BlueShield of Utah has named Jim Guemple market president. 

Centene will pay South Carolina $25.9 million to settle allegations the company overcharged the state's Medicaid program for pharmacy services. 

UnitedHealth Group's Optum, the largest employer of physicians in the U.S., is seeking to acquire physician-owned Corvallis (Ore.) Clinic. 

Cigna and Raleigh, N.C.-based WakeMed have agreed to a two-year contract. 

A new CMS rule aiming to streamline Medicare Advantage and Part D prior authorizations took effect Jan. 1.

In July, Reps. Michael Burgess, MD, and Vicente Gonzalez, both of Texas, introduced gold-card legislation that would exempt qualifying providers from prior authorization requirements for Medicare Advantage plans. 

From CareFirst suing Johnson & Johnson over alleged anticompetitive biosimilar tactics to Humana accused of using an AI tool to wrongfully deny Medicare Advantage claims, here five lawsuits, settlements and legal developments involving payers that Becker's has reported since Dec.…

New York City-based Mount Sinai Health System could go out of network with UnitedHealthcare on Jan. 1 if the two sides are unable to reach a new contract. 

UnitedHealth Group has received multiple offers to offload its Brazil unit, Bloomberg reported Dec. 20. 

Springfield (Ill.) Clinic will be back in network with Blue Cross Blue Shield of Illinois for the first time in more than two years, BCBS told Becker's Dec. 22.