Payer

The last of 15 defendants have been sentenced in Santa Clara, Calif. for their roles in a $40 million statewide insurance scam involving "overpriced and unneeded" telehealth prescriptions and medical devices.

About 60 million people—nearly one in five Americans—live in rural areas and depend on their local hospitals for care. But rural American health care is fragile business. 

Challenges loom for Medicare Advantage in 2024, with payers reporting rising medical costs and lower growth expectations for the year. 

Open enrollment for the ACA exchanges is finished in most states and a record 21.3 million people are enrolled — a 30% increase year over year, or 5 million people.

The share of U.S. employees in healthcare plans funded by their employer rose from 2015 to 2021, a study published in the January issue of Health Affairs found. 

Nearly half of people with traditional Medicare are aligned with Accountable Care Organizations, CMS said Jan. 29. 

Five key changes could improve Medicare Advantage, SCAN Group CEO Sachin Jain, MD, wrote in Forbes Jan. 30. 

Humana is expanding its primary care business for seniors into three new markets in 2024 and adding new centers in eight existing markets.

The federal No Surprises Act is estimated to have prevented more than 10 million surprise medical bills during the first nine months of 2023, according to a Jan. 26 report from AHIP and the Blue Cross Blue Shield Association. 

Blue Shield of California Promise Health Plan is now offering its Medicaid members in Los Angeles and San Diego counties the opportunity to earn their GED diploma at no cost, a first of its kind program in the state.