Payer

CMS is launching a new Medicare alternative payment model designed to help people with dementia remain in their homes and provide better support to their caregivers. 

Patients are more likely to receive cancer screenings in their first year of Medicare coverage than in previous years, a study from Epic Research found. 

UnitedHealth Group subsidiary UMR incorrectly denied emergency room and urinary drug screening claims for 'thousands," the U.S. Department of Labor alleges in a lawsuit filed July 31 in a Wisconsin federal court.

Two U.S. representatives have introduced gold-card legislation that would exempt qualifying providers from prior authorization requirements for Medicare Advantage plans. 

CMS is projecting Medicare Part D premiums to decrease by 1.8 percent in 2024, the agency said in a July 31 news release. 

Around half of beneficiaries dually-eligible for Medicare and Medicaid are enrolled in Medicare Advantage, according to a July 31 analysis from KFF. 

As demand for GLP-1s such as Ozempic and Wegovy continues to surge, payers and self-insured employers are dropping coverage for the weight loss medications left and right.

Portland, Maine-based Martin's Point Health Care has agreed to pay $22.5 million to resolve allegations that it knowingly submitted inaccurate diagnosis codes for Medicare Advantage Plan enrollees to increase reimbursements from Medicare.

Elevance Health is rebranding its Amerigroup subsidiary as Wellpoint. 

Federal and state-based insurance marketplaces received around 140,000 applications from people who previously had Medicaid coverage in April, according to data from CMS.