CareFirst BlueCross BlueShield is suing CMS over its 2026 Medicare Advantage star ratings, alleging improper calculations cost the insurer an estimated $32 million in quality bonus payments. The lawsuit, filed Jan. 20 in the U.S. District Court for the District…
Medicare Advantage
Maryland is losing its longstanding rate-setting power for Medicare fee-for-service under CMS’ “achieving healthcare efficiency through accountable design” payment model. Commercial insurers are going to bear the brunt, needing to tackle about half of the state’s necessary savings and covering…
Clover Health CEO Andrew Toy is feeling bullish about his company’s AI positioning. “We are absolutely, in my mind, the AI leader in Medicare Advantage,” he said Jan. 15 at the J.P. Morgan 2026 Healthcare Conference in San Francisco. Clover…
Alignment Healthcare has California roots, but its CEO, John Kao, is confident about planting seeds for growth elsewhere. Mr. Kao weighed in on Alignment’s strategy Jan. 14 during the J.P. Morgan 2026 Healthcare Conference in San Francisco. Just days before,…
Clover Health reported 53% year-over-year growth in Medicare Advantage PPO membership, according to a Jan. 14 news release from the insurer. The growth translated to roughly 153,000 members, building on positive traction from 2025. The company is now expecting to…
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UnitedHealthcare has launched a six-month pilot program aimed at cutting Medicare Advantage payment processing times in half for independent rural hospitals in four states. The Rural Payment Acceleration Pilot will reduce average MA payment timelines from less than 30 days…
Republicans from the House Committees on Energy and Commerce and Ways and Means sent a letter Jan. 9 to the HHS Office of Inspector General over concerns of Medicare fraud in California. The letter focused on home health agencies and…
UnitedHealth Group commissioned two independent studies from actuarial firm Milliman highlighting Medicare Advantage savings for both the federal government and beneficiaries. UnitedHealth shared the studies the same day the Senate Judiciary Committee released a report on the insurer’s “aggressive strategies”…
Alignment Healthcare added roughly 65,000 members in 2025, bringing its total enrollment to about 275,300 as of Jan. 1. The Medicare Advantage insurer disclosed the 31% year-over-year growth on Jan. 12, following a strong annual enrollment period. The company has…
UnitedHealth Group leveraged “aggressive strategies” to secure higher-paying Medicare Advantage diagnoses, according to a Jan. 12 Senate report. The Wall Street Journal initially covered the news. Senate Judiciary Chair Chuck Grassley, R-Iowa, started an investigation into the insurer’s billing and…