Aetna has agreed to pay $117.7 million to resolve allegations that it violated the False Claims Act by submitting or failing to withdraw inaccurate diagnosis codes for its Medicare Advantage enrollees in order to increase payments from CMS. The settlement…
Payer
Gov. Tim Walz unveiled a proposal March 10 to eliminate managed care organizations from the state’s Medicaid program and replace them with a single statewide organization. Currently, about 45% of the state’s Medicaid spending and nearly 80% of basic care…
Elevance said it was “surprised and disappointed” by a recent CMS sanction threat, which would suspend enrollment in Medicare Advantage prescription drug plans, CFO Mark Kaye said March 10 at the Barclays 28th Annual Global Healthcare Conference in Miami. The…
Centene expects its ACA membership to fall nearly 40% by the end of 2026, company executives said March 11 at the Barclays 28th Annual Global Healthcare Conference. CEO Sarah London said the company ended 2025 with 5.5 million members in…
The Office of the Inspector General for HHS found 121,454 emergency department procedures were possibly billed incorrectly in 2021 and 2022, leading to over $15.1 million in improper or potentially improper payments. Medicare improperly paid physicians $922,524 and may have…
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The Congressional Joint Economic Committee identified an additional $13.4 billion contributing to higher Medicare Part B premiums in 2025 due to Medicare Advantage overpayments, according to a March 10 report. The committee relied on Medicare Payment Advisory Commission estimates. Overpayments…
The possibility of a state-based health insurance exchange in Mississippi is looking less probable, state Insurance Commissioner Mike Chaney told Mississippi Today in a March 10 report. “It might be too little, too late, because the dollars are not there…
Idaho Republican state lawmakers have introduced a bill to repeal Medicaid expansion, the Idaho Capital Sun reported March 9. Four things to know: 1. The proposed legislation would repeal Medicaid expansion on Jan. 1, 2028, removing about 90,000 Idaho residents…
L.A Care Health Plan is the largest Medicaid managed care organization in the U.S. with nearly 2.4 million enrollees, according to KFF. KFF used CMS data reflecting enrollment totals as of July 1, 2024 across the 42 states and Washington,…
Ten providers recently posted job listings seeking leaders in payer contracting and relations. Note: This is not an exhaustive list. Listings were compiled from job-seeker sites. 1. Albany (N.Y.) Medical Center seeks an assistance director of system payer contracting. 2.…