Payer Issues Archives - Becker's Payer Issues

Md. sues UnitedHealth over Medicaid contract | Elevance loses bid for quick star ratings recalculation | Calif. legislature passes prior auth bill | Cigna ties cash benefits to medical claims | Medicare's GLP-1 program gains traction

Elevance denied a quick star ratings redo + UnitedHealth sued over Md. Medicaid issues August 28, 2026 1. Maryland sues UnitedHealth for $380M over Medicaid administration issues Full story 2. Federal court denies Elevance’s bid for emergency 2026 star ratings…

Villages Health inks $541M MA fraud settlement | Grand jury: DeSantis team misused Centene funds | NJ man sentenced in $50M insurance fraud scheme | Employers' GLP-1 cost strategy: 6 notes | GuideWell names CFO

Villages Health settles MA fraud allegations + the latest in employers’ GLP-1 cost strategy August 27, 2026 1. Humana’s Villages Health to pay $541.5M to settle Medicare Advantage fraud allegations Full story 2. $10M from Florida’s Centene Medicaid settlement misappropriated…

No Surprises IDR volume up 77% | Ex-Optum employee sentenced for fraud | Insurers' underwriting losses skyrocket | Henry Ford Health's MA membership jumps 46% | Blue Shield of Calif. cuts 60 jobs

No Surprises arbitration costs hit $22B + insurers see massive underwriting losses August 26, 2026 1. Former Optum director sentenced to 3 years in prison for defrauding company Full story 2. No Surprises dispute volume grows 77% in one year,…

3 new payer presidents | Disney, Starbucks among employers reducing benefits | States reject Medicaid GLP-1 deal | Insurer margin recovery dampened by high costs: Moody's | Union health plan sues OhioHealth

Big employers cutting benefits amid rising costs + states reject Trump’s Medicaid GLP-1 deal August 25, 2026 1. From Disney to Starbucks, big employers are pulling every lever to contain health costs Full story 2. Highmark taps Aetna exec to…

Payer CEO calls for prior auth ban | The AI jobs payers want to fill | Short term plan marketing up as ACA enrollment falls: Study | Cigna accused of behavioral underpayments | Ore. to launch state-based marketplace

A payer CEO’s call to ban prior auth + short term plan marketing surges amid ACA struggles August 24, 2026 1. Health insurer CEO: ‘Make prior authorization illegal’ Full story 2. The AI jobs health insurers are looking to fill right…

SCAN doubles down on 'hostile marketing' | Aetna to cut MA broker pay | Mount Sinai policy draws payer cease and desist | Employer care costs to rise 9.5% in '27: Aon | Ore. eyes ACA enrollment caps

An unconventional MA ad campaign will run again this fall and Aetna is cutting broker pay August 21, 2026 1. ‘We’re in wartime’: As major insurers continue pulling back on Medicare Advantage, SCAN places another contrarian bet Full story 2.…

BCBS Tenn. drops AI work tracking tool | Medi-Cal plans decry asset limit crunch | Humana taps new CMO | The latest in the No Surprises saga | Wide gaps in Medicare coverage knowledge: Survey

An insurer pivots on AI work tracking tool + the latest in the No Surprises saga August 20, 2026 1. BCBS Tennessee pivots away from AI tool that monitored employee work Full story 2. Medi-Cal plans brace for ‘devastating’ asset limit crunch…

Payers struggle to prove AI's ROI | Lowest-rated MA plans in '26 | Health Net names CEO | Alignment wants whistleblower suit tossed | 10 UnitedHealth updates

Payers are struggling to prove AI’s financial value + JD Power’s lowest-ranked MA plans August 19, 2026 1. Lowest-rated Medicare Advantage plans for member satisfaction in 2026: JD Power Full story 2. Health plan CFOs struggle to prove AI’s value:…

Top MA plans by market | Costco, SCAN partner | Investors renew fight against UnitedHealth | 5 forces driving up insurance costs in '27 | 10 recent billing fraud cases

Costco enters the MA market with SCAN deal + what’s driving insurance costs up in ’27? August 18, 2026 1. Investors renew fight against UnitedHealth, claiming $237M in insider stock sales Full story 2. 5 forces driving up health insurance…

UnitedHealth could see tax increase | Centene taps new CFO | Providence to shut down health plan | Where prior auth data still falls short | Hidden TPA fees increase employers' bills: Study

The IRS wants to increase UnitedHealth’s tax bill + Providence will totally shutter its health plan August 17, 2026 1. UnitedHealth disputes IRS proposal to boost tax bill Full story 2. Providence Health Plan to shut down after Medicare Advantage…

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