West Virginia may have paid managed care organizations up to $32.4 million for ineligible Medicaid participants, according to an October audit report. The audit examined payments from 2019 to 2020 and was inspired by Louisiana audits involving Aetna. MCOs get…
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Many Medicare Advantage and Medicaid managed care plans lack robust behavioral health networks, according to an October brief from the HHS Office of the Inspector General. The OIG analyzed four MA plans and two Medicaid managed care plans across 10…
Blue Cross Blue Shield of Massachusetts is offering a voluntary separation program to about 18% of its employees — totaling nearly 800 people — a company spokesperson told Becker’s. Employees who are at least 55 years old and have worked…
Pennsylvania lawmakers introduced a bill in October to regulate AI use in health insurance, joining a wave of states attempting to add guardrails in the payer space, especially after an early draft of the One Big Beautiful Bill Act included…
A federal judge in Indiana has thrown out most claims in a whistleblower lawsuit accusing four insurers and six health systems of improperly billing the state’s Medicaid program, but left the door open for the case to continue. The lawsuit,…
Omaha, Neb.-based GS Labs, a currently nonoperational COVID-19 testing firm, is suing Aetna, alleging the insurer owes over $53 million for more than 100,000 claims related to COVID-19 testing services, according to an Oct. 6 court filing. GS Labs accused…
Cigna has agreed to settle a “ghost network” class-action lawsuit for $5.7 million, according to October federal court filings in Illinois. Plaintiffs Andrew and Andrea Hecht alleged that in 2021, they received bills from a hospital saying it was out…
Pittsburgh-based Highmark Health appointed Karen Hanlon as president, effective immediately. Ms. Hanlon will continue in her role as COO, according to an Oct. 8 Highmark Health news release. She is responsible for managing the operations of Highmark Health, Highmark Inc.,…
The Medicare Part D market is entering 2026 amid a period of contraction and recalibration. Premiums are ticking down on average, but plan options are shrinking as major insurers reassess the profitability of standalone drug plans under the effects of…
California Gov. Gavin Newsom has signed a bill into law allowing the state’s Department of Managed Health Care to waive prior authorizations for services or prescriptions that payers approve at least 90% of the time. Senate Bill 306 also requires…