Park Ridge, Ill.-based Clear Spring Health will exit the Medicare Advantage market entirely on June 1, discontinuing its remaining business across Illinois, Georgia, and Colorado. The insurer, founded in 2017, had more than 12,000 members enrolled in its MA plans…
Medicare Advantage
CMS has fined 13 health plans a combined $1.5 million for Medicare Advantage program violations spanning cost-sharing rules and Part D drug benefit administration. The penalties, issued May 1, stem largely from claims processing system errors that caused enrollees to…
CMS plans to fine Health First Health Plans $43,546 for failing to properly administer Medicare’s Part D transition supply policy, according to an April 29 notice from the agency. The insurer, part of the Rockledge, Fla.-based health system, had a…
CMS is imposing a $48,833 fine against a Providence PACE organization in Napa, Calif., according to an April 29 notice from the agency. The penalty was issued to Collabria Care, the name under which Providence Community Health Napa Valley holds…
A publicly accessible database powering CMS’ Medicare Advantage provider directory exposed Social Security numbers of healthcare providers, The Washington Post reported April 30. The Post downloaded the database and found dozens of provider Social Security numbers. The database had been accessible for…
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Alignment Healthcare reported first quarter revenue of $1.2 billion, a 33% increase from the same period last year, the company said April 30. Medicare Advantage membership reached approximately 284,800 at the end of the quarter, up 30.9% year-over-year. The insurer…
Centene is participating in CMS’ GLP-1 bridge program for Medicare Part D, CEO Sarah London said on an April 28 earnings call. Under the “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” model, CMS would leverage negotiated GLP-1 prices…
Humana will “adjust” Medicare Advantage benefits in 2027 as the gap between CMS funding and the cost of care has grown wider heading into this year’s bid cycle, company executives said April 29 during the insurer’s first-quarter earnings call. President…
HHS’ Office of Inspector General found CMS may have improperly paid more than $2.26 million for virtual check-in and e-visit services for Medicare enrollees, according to an April audit report. The audit window — which spanned Jan. 1, 2019, through…
A House bill introduced April 20 by a bipartisan group of representatives, five of whom are also physicians, aims to tighten Medicare Advantage prior authorization timelines and impose stricter denial policies. “Medicare is a promise to America’s seniors that they…