Mail-order pharmacies owned by UnitedHealth and Humana dispensed Medicare prescription refills earlier and more frequently than industry peers, according to an analysis of federal prescription data published Dec. 26 by The Wall Street Journal. The analysis found mail-order pharmacies filled…
Author: Jakob Emerson
More than 15.6 million people have enrolled in plans on federally run ACA exchanges so far, down from about 16 million at the same point last year, CMS Administrator Mehmet Oz, MD, said Dec. 23. Dr. Oz attributed the decline…
A federal judge has granted UnitedHealthcare and PacificSource preliminary injunctions that block Idaho from taking action against the insurers over their Medicare Advantage broker compensation practices. The insurers sued Idaho Insurance Director Dean Cameron in November after the state issued…
Fourteen House lawmakers are calling on federal officials to investigate Elevance Health’s new policy that will penalize hospitals that use out-of-network providers, arguing the approach is anti-competitive and undermines the No Surprises Act. On Dec. 18, the bipartisan group of…
UnitedHealth Group has released findings from multiple independent reviews of its business practices following a June pledge from CEO Stephen Hemsley to conduct a transparent and comprehensive examination of company processes. The reviews, conducted by FTI Consulting and Analysis Group,…
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When Patrick Gilligan was interviewing for the top job at Point32Health earlier this year, he knew the nonprofit insurer was struggling. But Mr. Gilligan, a 30-year industry veteran who has worked on both sides of the payer-provider divide, saw something…
CMS is seeking input on whether its risk adjustment system disadvantages smaller Medicare Advantage plans, and one regional plan CEO says the answer is an emphatic yes. In its 2027 proposed MA rule, CMS said it recognizes the current risk…
CMS is terminating its Medicare Advantage contract with American Health Plan of Texas after the insurer failed to meet minimum quality standards for three consecutive years. The agency issued a notice of termination Dec. 17 to the Franklin, Tenn.-based company,…
The American Hospital Association and Federation of American Hospitals are calling on Elevance Health to rescind a new policy that would penalize hospitals for using out-of-network providers. In a Dec. 17 letter to Elevance President and CEO Gail Boudreaux, AHA…
Payers have faced state penalties in 2025 for slow reimbursements, improper claims denials, and mental health parity violations. Fines in 2024 are here. Payers fined by states in 2025: