Oregon regulators have released ATRIO Health Plans from state supervision three months after finding the Medicare Advantage insurer was in a “hazardous financial condition.” The Oregon Division of Financial Regulation terminated the supervision July 14, saying the conditions that prompted…
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Jefferson Health is alleging Independence Blue Cross used a string of reimbursement policy changes this year to cut what it pays the health system by an amount approaching $100 million in a new lawsuit. The July 22 complaint, filed in…
Santa Clara Family Health Plan CEO Christine Tomcala plans to retire later this year after 11 years leading the insurer. The San Jose, Calif.-based plan’s governing board voted to appoint COO Chris Turner as interim CEO effective upon her retirement…
HHS and CMS appealed a Maryland federal court’s decision to vacate parts of CMS’ 2025 “Marketplace Integrity and Affordability Rule,” according to July court filings. In the case — which has the city governments of Columbus (Ohio), Baltimore and Chicago, as well as…
The Mississippi Insurance Department is revoking the licenses of 59 insurance agents accused of fraudulently selling ACA marketplace plans while living outside the state. All 59 agents were served notice of a hearing in June, but none appeared at the…
Indiana Health Coverage Programs got CMS approval to progress with an enrollment and certification moratorium for some Medicaid providers beginning Aug. 1. According to a July 23 bulletin, the freeze will continue for six months. IHCP can extend the pause in six-month…
Artificial intelligence is now embedded across health insurance and care delivery operations, but Aetna’s chief medical officer says the industry still has a choice in what it accomplishes with the technology, even if early results aren’t encouraging. “AI opens the…
Molina Healthcare will continue to shrink its exchange business, President and CEO Joseph Zubretsky said on a July 23 earnings call. The insurer plans to focus on its marketplace membership in roughly six states versus the 13 or 14 the…
A former employee of Cambia Health Solutions has accused the Portland, Ore.-based company of violating the False Claims Act by knowingly submitting inaccurate diagnosis data to CMS and failing to return Medicare Advantage overpayments. The whistleblower complaint, originally filed in…
Committees in the House and Senate each advanced healthcare price transparency legislation this week, both aiming to expand disclosure requirements for hospitals, insurers and other healthcare providers. Both measures would expand the existing hospital and payer price transparency rules, bring…