Payer

Centene has agreed to pay Indiana more than $66 million to settle allegations it overbilled the state's Medicaid program for pharmaceutical services. 

Humana posted revenues of nearly $93 billion in 2022 and a net loss of $15 million in the most recent quarter, according to its year-end earnings report published Feb. 1. 

BlueCross BlueShield of Tennessee has completed its first annual health equity report and will use the findings as a benchmark to drive further progress, Andrea Willis, MD, chief medical officer for BCBS Tennessee, said in the Tennessean Jan. 26. 

Medicare Advantage plans will face tougher auditing standards after a highly-anticipated ruling from CMS. The program also hit 30 million members in recent weeks, and payers are expecting enrollment numbers to keep climbing. 

A trio of U.S. representatives has reintroduced a bill that would rename Medicare Advantage plans, prohibit private insurers from using "Medicare" in plan titles or advertisements and impose "significant fines for any insurer that engages in this deceptive practice."

A group of senators is seeking answers from major payers over "ghost networks" that make it difficult for patients to find in-network mental healthcare providers. 

Organizations representing payers say tougher auditing standards CMS will impose on Medicare Advantage plans could create higher premiums and fail to target fraud. Others say the new rule, which eliminates the fee-for-service adjuster, doesn't go far enough. 

CMS is opening an ACA special enrollment period for those losing healthcare coverage after the end of Medicaid's continuous enrollment provision. 

State Medicaid departments had been waiting for more than a year for certainty of when the unwinding of Medicaid's continuous coverage provision would begin, according to Kate McEvoy, executive director of the National Association of Medicaid Directors. 

A bipartisan group of senators are once again pushing for new regulations around the pharmacy benefit manager industry.