CMS elevated Clover Health’s Medicare Advantage star rating from 3.5 to 4.5 for its largest contract, according to a June 9 regulatory filing. Clover’s PPO covers 97% of its members, and the litigation did not include Clover’s HMO contract, which…
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MultiPlan, now rebranded as Claritev, has been at the center of multiple sprawling legal challenges regarding its repricing tools. While some battles have been ongoing, others are just gaining steam. MultiPlan, a data analytics firm, offers payers tools to inform…
The shift to outpatient orthopedic surgery has raised the stakes on post-operative pain management. Health systems and ASCs are under pressure to reduce opioid exposure while maintaining effective pain control and avoiding readmissions. The NOPAIN Act changes the math. It…
Jul 14, 2026 11:00 AM - 12:00 PM CDT
Presented by:
Presenters:
- Tammy Smittle, R.N., B.S.N., M.H.A.
- Stephanie Muh, M.D.
CMS issued guidance June 11 outlining plans to update its assessment of Medicaid section 1115 demonstration projects. Section 1115 demonstration projects allow states to test approaches for delivering and paying for Medicaid care. The June guidance stems from an HR…
A District of Columbia federal judge dismissed a lawsuit, proposed as a class action, June 10 that challenged denials of Zepbound to treat obstructive sleep apnea. The lawsuit, filed by Martin Hamburger, alleged denials by the pharmacy benefit manager CVS…
The contingent clinical labor market is more expensive and uneven than most health systems realize. Rates, fill times and supply risk climb at different speeds across specialties, and the systems that spot those shifts first protect their margins. This webinar…
Jul 23, 2026 12:00 PM - 1:00 PM CDT
Presented by:
Presenter:
- Jessica Fong
Iowa’s state auditor, Rob Sand, released a report raising concerns about how pharmacy benefit managers handled prescription drug payments within Iowa Medicaid and whether the state had sufficient access to information to oversee those arrangements. The June 10 report found…
The U.S. Office of Personnel Management issued a letter June 10 to Federal Employees Health Benefits and Postal Service Health Benefits carriers on fraud, waste and abuse compliance requirements. The letter reiterates expectations of carriers, the office said. Robust FWA efforts…
Centene’s Meridian of Illinois named Henish Bhansali, MD, chief medical officer. Dr. Bhansali shared the update June 10 on LinkedIn. He will work across Medicaid and other government products, including the dual-eligible special needs plan Wellcare Meridian Dual Align. “I…
CMS has named Melissa Fannin as chief of workforce strategy. “I am honored to rejoin the Centers for Medicare and Medicaid Services, this time as an SES Political in the Office of the Administrator,” she wrote on Linkedin on June…