St. Louis-based Mercy and Humana have opened two joint primary care clinics for older adults. The first two clinics in Springfield, Mo., and Nixa, Mo., opened in June, according to a June 12 news release. The clinic sites will be…
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The federal government will spend an estimated $86 billion on Medicare Advantage supplemental benefits in 2025, according to a report from the Medicare Payment and Advisory Commission. MedPAC, which advises the federal government on Medicare policy, published the report to…
Chapel Hill-based UNC Health has filed lawsuits against Aetna and Humana, alleging both insurers underpaid for 340B drug claims in violation of their contractual agreements. The lawsuits, filed June 10 in a North Carolina federal court, claim the payers improperly…
Generative AI Pioneering the Future of Utilization Management The healthcare industry is rapidly positioning Generative AI (GenAI) at the forefront of Utilization Management (UM) reform. Far from being a speculative technology of the future, GenAI is here to transform stagnant…
Congress is tasked with making decisions that affect health coverage for millions of Americans — but what kind of insurance do lawmakers have? Senators are weighing the “One Big Beautiful Bill,” a sweeping budget package. According to the Congressional Budget…
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Payers have faced state penalties in 2025 for slow reimbursements, improper claims denials, and mental health parity violations. Fines in 2024 are here. Payers fined by states in 2025:
UnitedHealth Group and Optum have settled a lawsuit filed by two former employees who had alleged that the company violated state and federal employee notification laws during mass layoffs in August 2023. The lawsuit, filed in the District Court for…
Medicare Advantage members are most likely to disenroll from their health plan because of four main reasons: difficulty accessing care, low plan generosity, dissatisfaction with care quality, and the type of plan (HMO vs. PPO), according to a June study…
The Trump administration has boosted payment rates for Medicare Advantage plans, but is also planning what it calls “aggressive” steps to ramp up audits of potential overpayments. Here are seven things to know about the Trump administration’s approach to Medicare…
Enrollment in Blue Cross Blue Shield plans declined slightly between 2022 and 2024, according to a June 10 report by Mark Farrah Associates, a healthcare industry data aggregator. The report examined differences between BCBS and non-BCBS plan growth between 2020…