The Labor Department is proposing a rule that would set criteria for employer associations to sponsor association health plans that qualify as employee welfare benefit and group health plans under the Employee Retirement Income Security Act. Received by the Office…
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Federal enforcement around Medicare Advantage risk adjustment and billing has ramped up over the past two years, producing multimillion-dollar settlements with insurers, provider groups, and the vendors that handle their diagnosis coding. The combined value of the settlements comes to…
Florida Attorney General James Uthmeier has filed a lawsuit against Prime Therapeutics and Cigna’s Express Scripts, alleging the pharmacy benefit managers entered into an illegal horizontal price-fixing agreement that threatens access to affordable medications. The lawsuit alleges the competitors entered…
A federal judge has denied Elevance Health’s request for an emergency recalculation of its 2026 Medicare Advantage star ratings. On Aug. 27, U.S. District Judge Lisa Godbey Wood ruled that Elevance waited too long to file for the emergency recalculation…
Cigna Healthcare is launching a product that bundles supplemental health benefits directly into high-deductible health plans. The product, Medical with Smart Coverage, will be available in 2027 for employers with 500 to 2,999 employees offering qualifying HDHPs. Eligible employees can…
Fort Myers, Fla.-based Lee Health said it would terminate hospital and physician contracts with UnitedHealthcare at the end of 2026. Beginning Jan. 1, 2027, Lee Health will be out of network for UnitedHealthcare employer-based, individual and Medicare Advantage plan members.…
The California Legislature has passed a California Medical Association-backed bill that extends the validity of approved prior authorizations to one year, and the bill now heads to Gov. Gavin Newsom’s desk. The bill requires health plans and insurers to honor…
Maryland Attorney General Anthony Brown has filed a lawsuit against UnitedHealth Group and Optum, seeking $380 million in damages stemming from alleged issues administering a Medicaid behavioral health program. “Marylanders in crisis and the providers who care for them rely…
Amid an industry landscape where the largest insurers have spent years diversifying their portfolios, one regional payer is betting that the current wave of financial disruption is presenting an opportunity to grow. WPS Health Solutions, an 80-year-old nonprofit insurer headquartered…
Medi-Cal enrollment decreased by 730,000 members from June 2025 to March 2026. The data came from the California Department of Health Care Services. A July analysis from California Health Care Foundation Senior Program Officer Diana Camacho said overall Medi-Cal enrollment…