Payer

A Tulsa, Okla., man was sentenced to 54 months in prison for a scheme that involved submitting more than $30 million in claims to major payers for COVID-19 testing services that were never performed. 

Anthem Blue Cross and Blue Shield in Virginia has partnered with value-based physician platform Aledade to expand access to primary care for more than 150,000 Medicaid beneficiaries across Virginia.

Cigna's Medicare Advantage business may have a potential buyer, and Washington is ramping up scrutiny on prior authorization and transparency in the program. 

Medicare Advantage rate changes will have a ripple effect through UnitedHealth Group's business in 2024, but its leaders have a sunny outlook despite lower projected growth. 

SelectCare of Texas, a Centene subsidiary, received an estimated $5.1 million in net Medicare Advantage overpayments in 2015 and 2016, according to an audit from HHS' Office of Inspector General published Nov. 27. 

Centene's Ambetter Health is partnering with health benefits platform Take Command to offer individual coverage health reimbursement arrangements to employers in Indiana starting next year. 

North Carolina's Medicaid expansion program began Dec. 1. 

Fourteen states gave managed care organizations payments for Medicaid enrollees for months after beneficiaries had died, a series of HHS Office of Inspector General audits found. 

Employers will be expecting insurers and vendors to deliver more transparency and ways to cut healthcare spending in 2024, according to the Business Group on Health. 

Optum patients who are enrolled in fully accountable Medicare Advantage plans — where Optum takes full financial and clinical responsibility — have better health outcomes than patients enrolled in traditional Medicare, according to UnitedHealthcare CEO Brian Thompson.