CMS has lifted an enrollment sanction imposed on PACE Partners of Northeast Florida, effective Aug. 6. The enrollment suspension came after more than a year of regulatory action following compliance deficiencies identified during audits conducted in 2021, 2022 and 2023.…
Payer
U.S. Senators Elizabeth Warren, D-Mass., and Ron Wyden, D-Ore., are pressing UnitedHealth Group for details of a program that allegedly incentivized nursing homes to avert medically necessary hospital transfers for their residents. The Aug. 6 letter to UnitedHealth Group CEO…
Arkansas Gov. Sarah Huckabee Sanders is calling on the state’s insurance commissioner to reject proposed individual ACA rates filed by Centene and Arkansas Blue Cross Blue Shield. Centene’s QCA Health Plan requested a 54% rate increase, and BCBS’ HMO plan…
From naming a new CFO to announcing it is complying with criminal and civil investigations into its Medicare Advantage business, here are 12 updates on UnitedHealth Group and its subsidiaries that Becker’s has reported since July 15: 1. U.S. Sens.…
Major insurers are retrenching their Medicare Advantage strategies as federal cost‑containment measures and rising medical expenses squeeze profitability. Amid the growing financial pressures the industry has faced for nearly two years, the largest MA carriers are cutting supplemental benefits, exiting…
Advertisement
UnitedHealthcare is expanding cancer detection benefits for some commercial members in 2026. Some UnitedHealthcare fully insured plans will now cover the first diagnostic breast imaging, colorectal cancer detection service, and colonoscopy at any age and at no cost when recommended…
CMS is proposing a five-year experiment that would allow state Medicaid programs and Medicare Part D plans to cover GLP-1s for weight management on a voluntary basis, according to an Aug. 1 report from The Washington Post. Ozempic, Wegovy, Mounjaro…
Bloomington, Minn.-based HealthPartners is launching Simplica NextGen Copay, a health plan with no deductible or coinsurance for in-network care. With the plan, beneficiaries will also see what they’ll pay upfront before scheduling, according to an Aug. 4 HealthPartners news release.…
In its second quarter earnings call, Cigna Group executives detailed how the company is continuing to build its position as a key player in the high-demand GLP-1 market, using its insurance and pharmacy benefit arms to shape how the high-cost…
With second quarter earnings now reported, health insurers are navigating elevated medical cost trends that are hurting their profit margins, driven by increased member utilization of specialty drugs, behavioral health, and emergency services. In their calls with investors, executives specifically…