Oakland, Calif.-based Kaiser Permanente has agreed to pay $556 million to resolve allegations that it violated the False Claims Act by submitting invalid diagnosis codes for Medicare Advantage enrollees to obtain higher payments from the federal government. According to the…
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St. Louis-based Mercy has named Paul Davis president of contracting and managed care, effective Jan. 19. Mr. Davis joins the health system from Humana, where he served as national vice president of network development and contracting, according to a Jan.…
Democratic Gov. Kathy Hochul proposed several initiatives Jan. 13 that aim to shore up healthcare in New York state. Affordability has been a pressing concern among New Yorkers. In the news release, Ms. Hochul said she will direct the state’s…
Grocery chain Albertsons is suing the Cigna-owned pharmacy benefit manager Express Scripts for at least $10.9 million for alleged prescription underpayments, according to a Jan. 7 complaint shared by the National Community Pharmacists Association. The lawsuit filed in Delaware’s Superior…
L.A. Care Health Plan is laying off 225 employees by March 13. The insurer told Becker’s the move affects 3% of its workforce and was driven by federal and state Medi-Cal budget reductions, which subsequently led to organizational restructuring. Impacted…
From a Senate report finding the company used “aggressive strategies” to secure higher-paying Medicare Advantage diagnoses to Optum beginning a review of Minnesota Medicaid claims, here are 10 updates on UnitedHealth Group and its subsidiaries that Becker’s has reported since…
Aetna Better Health of Kentucky named Chris Lindy as its new CEO, according to a Jan. 14 LinkedIn post from Jennifer Ruehl Nachreiner, the plan’s COO. Mr. Lindy will oversee health plan operations, drive clinical outcomes, establish partnerships and a…
Through a collaboration with Evolent — a health technology company focused on managing complex care — Florida Blue achieved a 40% drop in hospital and emergency room visits for Medicare Advantage members with cancer, according to a Jan. 14 news…
Four hospitals under Grand Rapids and Southfield, Mich.-based Corewell Health are no longer in UnitedHealthcare’s network, according to a Dec. 31 update from the insurer. As of Jan. 1, UnitedHealthcare does not cover the Dearborn, Taylor, Trenton and Wayne hospitals…
Clover Health reported 53% year-over-year growth in Medicare Advantage PPO membership, according to a Jan. 14 news release from the insurer. The growth translated to roughly 153,000 members, building on positive traction from 2025. The company is now expecting to…