Independence Blue Cross has agreed to pay $22.5 million to resolve allegations that it used inaccurate diagnosis codes to inflate its Medicare Advantage payments, according to a Sept. 30 Justice Department news release. The government alleged the insurer violated the…

Many major health insurers are pulling back from some counties in 2027, while Singh Holdings, Blue Cross of Idaho and Devoted Health boosted their footprint. CMS released data Sept. 28 on the 2027 Medicare Advantage landscape, showing which counties insurers…

CMS released initial insights on the 2027 Medicare Advantage landscape Sept. 28, along with data breaking down plans. One wrinkle gaining attention: enrollment capacity limits. In April, CMS said insurers could include enrollment caps for specific plans in their 2027…

UnitedHealthcare’s Medicare Advantage business in Texas received an estimated $24.4 million in overpayments during 2020 and 2021 tied to diagnoses not supported by medical records, the HHS Office of Inspector General said in an audit report published Sept. 28. The…

In 2026, 4.6 million Medicare Advantage beneficiaries, or 16% of enrollees, experienced disruptions to their health plan, according to a recent brief from the Alliance of Community Health Plans and consulting firm HealthScape Advisors. Hospitals have been dropping MA plans,…

Plans are expecting Medicare Advantage enrollment of 34 million beneficiaries in 2027, or about 47.4% of all Medicare enrollees, according to a Sept. 28 CMS news release. This would be flat compared with the 2026 projection, but actual MA enrollment…

Medicare Advantage plan choice will fall in more than half of states in 2027, even as CMS projects lower average premiums and a nearly unchanged number of available plans nationwide. The decline follows widespread disruption in 2026, when as many…

While Medicaid Fraud Control Units have existed under federal law since 1977, the units have received renewed attention amid the Trump administration’s fraud, waste and abuse crackdown. KFF recently broke down the role of these state-level law enforcement entities and…

CMS is working with 37 states on quality measurement in Medicaid and the Children’s Health Insurance Program, the agency shared Sept. 25. The initiative, called “Investing in Health Outcomes,” allows states to sign onto a voluntary pledge centered on prioritizing…

Tennessee’s Medicaid program claimed $59.3 million in federal reimbursement for case management services provided to children who did not qualify for them, the HHS Office of Inspector General said in an audit report published Sept. 23. The OIG’s recommendations are…