A federal judge has vacated a CMS rule that would have allowed the agency to claw back billions of dollars in alleged Medicare Advantage overpayments, siding with Humana in a closely watched legal battle. On Sept. 25, the U.S. District…
Author: Jakob Emerson
Regional, nonprofit health plans are falling behind large national insurers, with 71% recording an operating loss in 2024 and more than half having two years or less before regulatory intervention is triggered, according to a Sept. 24 report from HealthScape…
Oncology care company Thyme Care has raised $97 million in a Series D funding round backed by major insurers Humana and CVS Health, as well as JPMorgan’s Morgan Health division. The round also drew support from Texas Oncology and Houston-based…
CMS has formally terminated UCare’s Medicare Advantage contracts after the insurer declined to sign agreements for 2026. The move impacts about 158,000 MA members in Minnesota and western Wisconsin, where UCare is the second-largest MA carrier with 26% market share.…
A federal judge has granted preliminary approval to Elevance Health’s $12.9 million settlement resolving a class action lawsuit that accused the insurer of improperly denying coverage for residential treatment of mental health and substance use disorders. The lawsuit was originally…
Advertisement
Dan Kueter is the CEO of UnitedHealthcare’s employer and individual insurance business, an $80 billion division and the nation’s largest company that offers health coverage to employers nationwide. Mr. Kueter has been with the company since 2001 and has served…
In one of the largest shifts in the Medicare Advantage landscape in recent years, Health Care Service Corporation has nearly quadrupled its Medicare Advantage membership after closing on a $3.3 billion acquisition of Cigna’s Medicare business in March. The deal,…
Aetna is expanding a program that aims to reduce readmissions for its Medicare Advantage members to ten hospitals by the end of 2025. The insurer is currently implementing the clinical collaboration program at Merriam, Kan.-based AdventHealth Shawnee Mission, Houston Methodist,…
The National Committee for Quality Assurance has once again named the highest-quality and most effective health plans in the country, with Blue Cross Blue Shield of Massachusetts remaining at the top. On Sept. 16, the NCQA released its 2025 ratings…
CMS has finalized a rule requiring Medicare Advantage plans to submit provider directory data for inclusion in the Medicare Plan Finder. The change, aimed at improving transparency and beneficiary decision-making, takes effect January 1, 2026. Under the rule, MA plans…