Hospitals and insurers have been fighting an AI billing war for the better part of two years, with providers deploying the technology to optimize and defend their coding, and payers using it to audit and push back. “AI is placing…

The HHS Office of Inspector General sent a letter June 30 informing New York officials that federal grant funds to the state’s Medicaid fraud control unit are suspended effective July 1. New York gets roughly $60 million in taxpayer dollars…

CMS is rolling out the Medicare GLP-1 Bridge program — a demonstration designed to give eligible Medicare Part D beneficiaries access to certain GLP-1s at a fixed monthly cost — July 1. CMS officials, including CMS Administrator Mehmet Oz, MD,…

Centene executives are hoping to unlock healthy food as a Medicare Advantage benefit more broadly. In a May 11 Health Affairs article, Centene leaders and a University of California, San Francisco, professor made the case for CMS to expand access…

Medica will no longer offer individual marketplace plans in Iowa, Kansas and Oklahoma, effective January 1, 2027.  The decision affects about 4,000 members in Iowa, 600 members in the Kansas City area in Kansas, and 8,400 members in Oklahoma, the…

Sustainability has become less about cutting costs and more about redesigning how healthcare delivers value. Becker’s asked several health plan leaders how they’re thinking about long-term sustainability, and the responses point to a shared shift away from volume-driven models toward…

Blue Cross Blue Shield of Massachusetts will discontinue all PPO and EPO plans in the merged market (the combined individual and small group markets in Massachusetts) after 2026, the company confirmed to Becker’s. The insurer said it will automatically map…

Maryland has approved midyear rate increases for CareFirst BlueCross BlueShield and UnitedHealthcare in the state’s small group market, citing a significant rise in inpatient hospitalizations and inpatient and outpatient surgeries. The approved rates came in below what both carriers requested,…

Centene’s ACA product in New Hampshire, Ambetter from NH Healthy Families, will discontinue coverage at the end of 2026. Provider agreements and member coverage will remain in effect until the end of the year, according to a June 26 update.…

Democratic governors and attorneys general from 25 states and Washington, D.C., sued the Trump administration June 29 over CMS’ interim final rule implementing Medicaid work requirements. Eight things to know: 1. The 74-page lawsuit, filed in U.S. District Court for…