Payer

A startup integrating Western medicine and Eastern wellness benefits in Medicare Advantage clinched $41 million in a funding round led by Google Ventures. 

Medicare Advantage plans should be aware of fraudsters turning their efforts to private plans, HHS' Inspector General Christi Grimm said. 

Humana's longest-serving director, David Jones Jr., is planning to retire after 30 years on the company's board, WDRB reported March 20. 

Payers and some provider groups are pushing back on a slate of proposed Medicare Advantage regulatory changes from CMS. Here are nine updates about the program Becker's has reported since March 7. 

New York provides the most comprehensive behavioral health coverage to fee-for-service Medicaid beneficiaries, while South Carolina provides the least, according to an analysis published March 17 by Kaiser Family Foundation.

Mississippi Gov. Tate Reeves vetoed a pair of bills that aimed to speed up the prior authorization process and fine health insurers for inequalities in reimbursement rates, the Mississippi Free Press reported March 16. 

Novel therapeutics are innovative pharmaceutical and biotech products that improve clinical outcomes, but payers face many challenges when deciding whether to cover them, according to a new report from the Center for Connected Medicine at Pittsburgh-based UPMC and KLAS Research.

Florida has been supervising Bright Health's operations in the state since last fall and plans to continue until at least May 1.

As CMS prepares to implement tougher risk adjustment data validation audits in Medicare Advantage, payers and providers can take steps to boost their compliance efforts. 

Florida lawmakers are looking to limit residents' ability to sue insurance companies in an effort to decrease costs, the Miami Herald reported March 14.