A shareholder is suing the Cigna Group in Delaware's Court of Chancery to obtain more information about the company's claims review process following a ProPublica report that alleges the company denies large batches of members' claims without individual review, Law360 reported Sept. 13.

The 4th U.S. Circuit Court of Appeals said Sept. 13 it won't review a lower court's ruling that certified class-action status in a lawsuit alleging Aetna and OptumHealth Care Solutions conspired to use "dummy code" to make administrative fees appear to be billable medical charges.

Common medical procedures can cost more than twice as much when they take place in a hospital outpatient setting compared to a physician office or ambulatory surgery center, according to an analysis published Sept. 14 by the Blue Cross Blue Shield Association.

CVS Health CEO Karen Lynch said she is "optimistic" Aetna will improve its Medicare Advantage star ratings for 2024. 

Some payers are reporting big savings with value-based care efforts. 

There is a small pool of executive candidates who can oversee millions of lives and produce positive financial results for large healthcare organizations, and payers have shown they are willing to take those executives to court when they leave for new opportunities.

Reactions to Blue Shield of California's decision to drop its contract with CVS Caremark to manage pharmacy benefits in favor of a partnership with five companies have been overblown, CVS Health CEO Karen Lynch said. 

The nation's largest Latino civil rights organization, UnidosUS, along with 12 other state and national organizations, have filed a complaint with the HHS Office of Civil Rights regarding what they say is Florida's "illegal discrimination" under the Civil Rights Act against families and children of color amid the state's Medicaid redetermination process.

Weight loss drugs like Ozempic and other GLP-1s exploded in popularity this year, resulting in drug shortages and increasing costs for payers and employers. 

Additional Medicaid coverage enacted during the COVID-19 pandemic helped keep the number of uninsured people down at record lows in 2022 even as poverty levels soared, according to a Sept. 12 New York Times report.

From payers announcing cuts, to a lawmaker investigation denials, here are five updates about prior authorizations Becker's reported since Aug. 17: 

Mississippi could consider Medicaid expansion next year, Mississippi Rep. Jason White told Mississippi Today. 

The majority of older adults say they would stick with their current Medicare plan rather than switch to a different plan when they feel they have too many options, a survey from the Commonwealth Fund found. 

Humana offers the best Medicare supplement plan in 2023, according to a ranking published Sept. 7 by Forbes Health.

Elevance Health is seeking to block a former regional Medicare president from taking a similar role at Molina Healthcare, alleging the former executive is in possession of trade secrets that would inevitably be disclosed to Molina. 

Medicaid spent $1.1 billion on Ozempic and other GLP-1 drugs that can be used for weight loss in 2022, a KFF analysis published Sept. 8 found. 

Much of Medicare Advantage growth is driven by people switching to the program from traditional Medicare, and this growth is picking up speed in rural areas. 

The Medicaid disenrollment rate for reporting states as of Sept. 8 ranges from 72 percent in Texas to 9 percent in Michigan, according to KFF. 

L.A. Care Health Plan has agreed to pay a $1.3 million settlement and to implement a corrective action plan to resolve allegations that it violated HIPAA regulations.

Humana is challenging a rule from CMS that could leave insurers on the hook for billions in repayments, and new HHS research reveals most growth in the program is fueled by people switching from traditional Medicare.