Medicare Advantage has long been viewed as a strong alternative to traditional Medicare, but the program has “deteriorated significantly” in recent years — benefitting commercial payers at the expense of patients and providers, according to Providence President and CEO Erik…
Author: Alan Condon
Oakland, Calif.-based Kaiser Permanente has agreed to pay $556 million to resolve allegations that it violated the False Claims Act by submitting invalid diagnosis codes for Medicare Advantage enrollees to obtain higher payments from the federal government. According to the…
Health plans were early adopters of AI, using it to streamline claims processing, support call centers and manage utilization. Now, they’re ramping up AI deployment to enhance member experience, improve care quality and reduce administrative costs, according to America’s Health…
Major payers reported mixed third-quarter results amid rising medical costs and operational headwinds, a stark contrast to the more robust performance seen by some of the largest for-profit health systems. Becker’s compared Q3 performance across six major payers — UnitedHealth…
CMS is set to launch a pricing model in January that could reshape Medicaid drug costs by aligning them with rates seen in other high-income countries. Eight things to know: 1. The program allows participating drug manufacturers to offer Medicaid…
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Highmark Health Plan has appointed Kate Musler CFO. Four things to know: 1. Ms. Musler previously served as senior vice president of risk management and provider networks for Highmark Health Plan, where she was responsible for actuarial, underwriting and provider…
Texas Attorney General Ken Paxton's Healthcare Program Enforcement Division has secured a $40 million settlement from Molina Healthcare under the Texas Health Care Program Fraud Prevention Act.
Donald Trump's second term as president likely will have significant implications for healthcare, including the Medicare Advantage program, which provides health coverage to more than half of the nation's older adults.
Elevance Health sold Miami-based Pasteur Medical Centers and Wellmax Medical Centers to Las Mercedes Medical Centers, which is also headquartered in Miami.
St. Louis-based Mercy has notified Anthem Blue Cross Blue Shield that it will go out-of-network with the insurer in Missouri if a new agreement is not reached by Jan. 1, 2025.