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…
Author: Jakob Emerson
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…
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…
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…
Anthem Blue Cross of California is bringing its controversial out-of-network penalty policy to California on June 1, a move that has already drawn legislative backlash in the insurer’s home state of Indiana. Under the policy, participating hospitals and facilities in…
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L.A Care Health Plan is the largest Medicaid managed care organization in the U.S. with nearly 2.4 million enrollees, according to KFF. KFF used CMS data reflecting enrollment totals as of July 1, 2024 across the 42 states and Washington,…
Point32Health is laying off approximately 100 employees, or 2.3% of its workforce. “We regularly review our organization to ensure our teams and department functions are optimally set up to deliver for our members and customers,” spokesperson for the company told…
Humana’s President and CEO Jim Rechtin was paid $18.8 million in total compensation in 2025, the insurer said in regulatory filings published March 6. CFO Celeste Mellet was the company’s highest-paid executive in 2025, earning $18.9 million in total compensation,…
Oscar Health has promoted Louis DeStefano to chief growth officer and Kristen Prestano to SVP and chief marketing officer. Mr. DeStefano has been with the company since 2017 and previously served as SVP of growth. Ms. Prestano has been with…
Providence Health Plan recorded a $102 million net loss in 2025, driven by rising medical and pharmacy utilization and a drop to a 3.5 Medicare Advantage star rating, but the Oregon-based health plan is projecting a return to financial stability…