Blue Cross Blue Shield of Michigan and Blue Care Network are updating their professional “incident-to” services and billing reimbursement policy for eligible providers serving commercial members, according to a June provider newsletter. The incident-to billing practice permits services performed by…

CommunityCare and direct primary care technology company Mending are partnering to embed DPC providers into Oklahoma ACA plans beginning in 2027. Mending, which is winding down its own ACA plans in Maine and Oklahoma, will shift to powering DPC access…

The Justice Department has charged 455 defendants, including 90 physicians, nurses and other licensed medical professionals, for allegedly participating in healthcare fraud and opioid abuse schemes. The charges are part of the department’s 2026 National Healthcare Fraud Takedown, which is…

A man charged in connection with one of the largest Medicare fraud schemes in U.S. history is back in American custody after being apprehended in Northern Cyprus and flown to South Florida, the Justice Department said June 23. Ibrahim Khaldoon…

It’s not every day the country’s largest healthcare company provides on-the-record access to its senior leadership team, no topics barred. But that is exactly what UnitedHealth Group has done, inviting reporters and social media influencers to its corporate headquarters in…

Health plans are facing a convergence of pressures unlike anything in recent memory. Clinical cases are growing more complex as people suffer from more chronic conditions. Regulatory expectations continue to rise. Finances are under constant scrutiny. And through all of…

Earlier in June, the HHS Office of Inspector General published two reports shedding light on post-acute care denials and overturned appeals from Medicare Advantage organizations. AHIP is pushing back. “The reports ignore serious, well-documented concerns about wide variations in the…

Community Behavioral Health, a Medicaid behavioral health managed care plan in Philadelphia, didn’t meet federal and state requirements around prior authorization denials, according to a June audit report from HHS’ Office of Inspector General. CBH received about $1.28 billion in…

Luigi Mangione’s defense team has withdrawn its plan to mount a psychiatric defense at his New York state murder trial in the death of UnitedHealthcare CEO Brian Thompson. The reversal came one day after Manhattan Judge Gregory Carro said during…

Clover Health’s PPO, the company’s largest contract covering 97% of members, already secured a Medicare Advantage star ratings boost from 3.5 to 4.5 stars following litigation. Now, the insurer’s smaller HMO contract is also seeing a bump. According to a…