A federal judge has dismissed Ballad Health’s lawsuit accusing UnitedHealth Group of denying and underpaying Medicare Advantage claims, ruling the dispute must go to arbitration. Johnson City, Tenn.-based Ballad sued UnitedHealth in October, alleging the insurer spent years denying valid…
Medicare Advantage
As insurers and provider-sponsored health plans reassess their exposure to Medicare Advantage, Detroit-based Henry Ford Health is moving in the opposite direction. Medicare Advantage enrollment at Health Alliance Plan by Henry Ford Health surged 45.8% year over year to 132,566…
UnitedHealth Group says its Medicare Advantage business is outperforming initial margin targets for 2026, crediting deliberate financial recovery moves that meant fewer members this year. Speaking at a Wells Fargo conference Sept. 9, CFO Wayne DeVeydt said the company “really…
Beginning Oct. 1, Mass General Brigham Health Plan will remove Dana-Farber Cancer Institute from its Medicare Advantage network. MGB Health Plan operates and makes network decisions “separately, independently and without influence from” the Somerville, Mass.-based Mass General Brigham, according to…
CMS has been cracking down on possible fraud with medical equipment suppliers for months, sharing two major updates in recent weeks. CMS announced that it is barring 11 medical supply companies focused on durable medical equipment, prosthetics, orthotics and supplies…
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In August, SCAN Health Plan announced a partnership with Costco Wholesale Corp. to sell insurance products for older adults. Sound familiar? Costco is not the first retailer to partner with a Medicare Advantage insurer. Kroger has worked with Select Health…
CMS has taken a series of enforcement actions against Medicare Advantage plans over the last two years, suspending enrollment and terminating contracts over issues ranging from network adequacy to financial solvency failures. Eight updates:
Over a six-year period, Medicare may have spent $380 million on organs that were not ultimately used in covered enrollee transplants, according to a September HHS Office of Inspector General report. Under federal law, Medicare can only reimburse certified transplant…
Medicare Part D sponsors paid pharmacies $587.7 million for some over-the-counter drugs with obsolete prescription-only labels, despite CMS oversight. Medicare Part D does not cover OTC drugs. According to an Aug. 31 HHS Office of Inspector General report, Part D…
CMS has again suspended enrollment for two Medicare Advantage prescription drug plans offered by Boston-based eternalHealth, the second time in less than two years that the insurer has faced sanctions. The agency said Aug. 27 the enrollment freeze on the…