Payer

Medicare Advantage plan enrollees have lower expenses than those with similar risk scores who remain in traditional Medicare, but payments to the program are based on traditional Medicare, according to a whitepaper from researchers at the University of Southern California…

Potentially hundreds of homeless individuals in Florida were signed up for ACA exchange plans they could not afford in a fraud scheme, according to a June 13 report from KFF Health News. 

More than 1 million people have been disenrolled from Medicaid as part of the redeterminations process, according to KFF. 

Ten providers recently posted job listings seeking leaders in payer contracting and relations.

Some health insurers are cracking down on off-label prescriptions of new weight loss drugs such as Ozempic, The Washington Post reported June 12.

CMS' proposed rules to improve drug price transparency in Medicaid is a "positive step" toward controlling costs, Kate McEvoy, executive director of the National Association of Medicaid Directors, told Becker's. 

A top Centene executive plans to retire next year, and the company is divesting its non-core businesses. 

The Biden administration has reached a tentative deal that would preserve a provision of the ACA requiring insurers to cover preventive services while a Texas judge's ruling against the mandate is appealed in court.

From rolling back a planned gastroenterology endoscopy prior authorization policy to making an unsolicited cash offer to acquire Amedisys, here are 10 updates on UnitedHealth Group Becker's has reported since May 22.    

New GLP-1 drugs to treat diabetes and obesity can be expensive, and most payers do not cover drugs only for weight loss for their members.