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Author: Rylee Wilson

Medicare Advantage legislation in Congress: 7 bills to know Federal lawmakers have introduced a handful of bills aimed at speeding up prior authorization and cracking down on upcoding in Medicare Advantage.  None of the introduced bills have been heard in…

New York state will bar insurers from compensating brokers for enrolling members in the state’s essential plan, beginning in 2026.  The essential plan is available to low-income adults in New York who do not qualify for Medicaid.  Andrew Biernant, vice…

UnitedHealth Group is complying with criminal and civil investigations into its Medicare Advantage business, the company said in a July 24 regulatory filing.  The disclosure comes after The Wall Street Journal reported in May that the Justice Department has been…

Payer leaders need a flexible mindset, data know-how and big-picture thinking to succeed in 2025, according to more than a dozen executives.  Becker’s reached out to 17 executives to learn what underrated skills set the best leaders apart.  Like what…

Humana has reintroduced a lawsuit challenging its Medicare Advantage star ratings.  On July 18, U.S. District Judge Reed O’Connor dismissed the case without prejudice. Mr. O’Connor ruled that Humana had not exhausted all of its administrative appeal options when it…

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Oscar Health is expecting to operate at a loss in 2025 as costs climb in the individual market.  The company reported preliminary results for the second quarter of 2025 on July 22, expecting a loss from operations of $200 million…

The Medicare Part D market is facing an “uncertain future,” according to an analysis from KFF published July 16.  The future of the Part D market depends on whether CMS extends the Part D premium stabilization program put in place…

St. Louis-based Mercy is targeting closer partnerships with fewer organizations, Gavin Helton, MD, president of primary care at the system, told Becker’s.  One of these partnerships is with Humana. Mercy and Humana opened their first collaborative 65Prime+ Clinics in Springfield…

A judge has dismissed Humana’s lawsuit challenging its Medicare Advantage star ratings.  In a July 18 order, U.S. District Judge Reed O’Connor dismissed the case without prejudice, meaning it could be reintroduced.  In his filing, Mr. O’Connor wrote that Humana…

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