• Aetna hits drugmakers with price-fixing lawsuit

    Aetna has filed a lawsuit against 20 major pharmaceutical companies, accusing them of engaging in a broad price-fixing conspiracy that artificially inflated the prices of certain generic drugs. 
  • BCBS North Carolina, Change Healthcare agree to $1.7M settlement in robocall lawsuit

    Blue Cross and Blue Shield of North Carolina and UnitedHealth's Change Healthcare have agreed to pay $1.67 million to settle a class action lawsuit accusing them of using automated technology to send voice messages to individuals without their consent.
  • Former Elevance exec sues over alleged age discrimination

    A former chief human resources officer at Elevance Health, Troy Henagan, has filed a lawsuit against the company in a Georgia federal court, alleging age discrimination after his termination in June 2024.
  • 7 Medicare Advantage study findings to know

    Recent studies examined how Medicare Advantage beneficiaries use hospice care and dental benefits, as well as the reasons behind differences in diagnosis coding between traditional Medicare and MA enrollees.
  • UnitedHealth named world's largest insurer for 10th straight year

    UnitedHealth Group is the world's largest insurer by net premiums written for a 10th year in a row, according to AM Best's annual ranking published Jan. 2.
  • Florida Blue latest to sue over Medicare Advantage star ratings

    Florida Blue is the latest insurer to sue CMS over its Medicare Advantage star ratings. 
  • 10 largest Medicaid managed care plans

    L.A. Care Health Plan is the largest Medicaid managed care organization in the country with more than 2.5 million enrollees, according to KFF.
  • Streamline your formulary management: 2025 USP Drug Classification

    For payers, drug formulary development and maintenance are essential for accurate reporting and tracking of prescription medications. An up-to-date and well-established classification resource can help payers and other stakeholders manage their drug formulary more efficiently. While several classification resources are available, the U.S. Pharmacopeia (USP) provides a drug classification system focused only on U.S. FDA approved drugs for use in outpatient care settings. This premium tool includes reporting and tracking terminology, as well as codes for crosswalking against other classification systems.
  • 40 payer execs' industry outlook for 2025

    The majority of health plan executives are focused on growth and have a favorable outlook for 2025, according to a Dec. 12 survey from the Deloitte Center for Health Solutions.
  • Humana's 2024 in 10 headlines

    Humana welcomed a new CEO in 2024 amid rising Medicare Advantage costs.
  • Elevance Health's 2024 in 10 headlines

    Elevance Health added several acquisitions in 2024. 
  • Top 10 health insurance stories of 2024

    The year 2024 proved to be a pivotal and tumultuous period for the health insurance industry, defined by the shocking murder of UnitedHealthcare's CEO and the largest cyberattack in the sector's history. Legal and regulatory battles over Medicare Advantage, significant policy shifts, and mounting public frustration with insurers underscored a year of upheaval.
  • 3 Medicare Advantage plans audited for $11.4M in overpayments

    HHS' Office of Inspector General estimated three Medicare Advantage insurers received around $11.4 million in overpayments. 
  • An unimaginable year for UnitedHealth

    The year 2024 will be remembered as one full of unprecedented challenges and turmoil for the nation's largest healthcare company. 
  • Medicare Advantage dental benefits lacking, study finds: 3 notes

    While most Medicare Advantage plans offer dental benefits, few of these benefits are comprehensive, a study published Dec. 26 in JAMA found. 
  • Medicare Advantage in the headlines: 7 recent updates

    An insurer reached a nearly $100 million settlement over allegations of overpayments, and CMS plans to sunset a value-based model over "unprecedented" costs. 
  • Sickness scores surged for UnitedHealth Medicare Advantage patients: WSJ

    UnitedHealth Group has optimized its ability to increase Medicare Advantage members' sickness scores and corresponding government payments by directly employing thousands of physicians at Optum and integrating sophisticated software tools into clinical workflows, according to a Dec. 29 investigation from The Wall Street Journal.
  • Health insurers confront climate change

    Climate change is becoming an increasingly urgent challenge for the health insurance industry.
  • Medicare Advantage insurer to pay up to $98M to settle false claims allegations

    Independent Health will pay up to $98 million to settle allegations a now-defunct subsidiary knowingly submitted invalid diagnoses to boost Medicare Advantage payments. 
  • Medicaid spending on weight loss, diabetes drugs up 500% since 2019: 5 numbers to know

    Medicaid could spend $29.9 billion on drugs to treat type 2 diabetes and weight loss, according to a report from HHS' Office of Inspector General. 

Articles We Think You'll Like