Payer

OIG audits found over $213 million in estimated Medicare Advantage overpayments in 2023. 

Approximately 65% of denied claims are not reprocessed for resubmission (Zindl, 2021). Amongst the many challenges facing the healthcare industry, denied claims only continue to rise. Many denied claims are never resubmitted. What does that mean for providers, and what…

Texas has placed Bright Health's subsidiary in the state into receivership and ordered its assets liquidated, according to a court order issued Nov. 29. 

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.