Seventeen percent of initial Medicare Advantage claims are denied, but 57% of originally denied claims are ultimately overturned, according to a study published June 2 in Health Affairs. The study analyzed 270 million claims from 2019 based on data from…
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Reps. Alexandria Ocasio-Cortez and Lloyd Doggett have asked U.S. Attorney General Pam Bondi to expand the Justice Department’s reported civil and criminal investigations into UnitedHealth Group to include allegations that the company has engaged in harmful and fraudulent cost-cutting tactics…
When medically complex patients require hospital care, they tend to experience longer recovery times than other patients do and are more likely to readmit to the ICU.1,2 Kindred Hospitals, a network of long-term acute care hospitals (LTACHs), is focused on…
From friction to function: 4 takeaways on fixing provider data to improve member access and trust
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During a featured panel discussion hosted by Kyruus Health at Becker’s Spring Payer Issues Roundtable, leaders from Highmark Health, Allegheny Health Network, Corewell Health and UCare came together to dissect one of healthcare’s quietest crises: provider data inaccuracy. The panel…
Nebraska Gov. Jim Pillen has signed the Ensuring Transparency in Prior Authorization Act, which aims to overhaul the prior authorization process in the state by making prior auth requirements publicly available on insurers’ websites and ensuring that providers are given…
UnitedHealth Group is exploring the sale of its Banmedica subsidiary, which operates in Colombia and Chile, Reuters reported June 9. The company has been trying to exit Latin America since 2022, but the reported sale has taken on increasing urgency…
Deceptive marketing practices, including deepfake AI versions of celebrities like Taylor Swift and Joe Rogan, have led to fraudulent enrollment in ACA plans in recent years, according to a June 5 report from Bloomberg. Primarily in 2022 and 2023, AI-created…
Vermont Gov. Phil Scott has signed legislation that grants the Green Mountain Care Board new powers to manage the financial health of hospitals and insurers in the state. The GMCB, an independent state agency in Vermont responsible for overseeing the…
The country’s largest Medicare Advantage carriers are backing significant proposed reforms to billing practices, along with new crackdowns and audits of the plans. CMS Administrator Mehmet Oz, MD, has promised scrutiny of the Medicare Advantage program amid allegations of widespread…
From sweeping federal healthcare policy proposals to upheaval at the nation’s largest insurer, these are the most impactful stories within the health insurance industry since the start of 2025. Medicaid proposals Republicans’ “One Big Beautiful Bill,” passed by the House…