Payer

Coventry Health and Life Insurance Co., an Aetna subsidiary, received an estimated $6.9 million in Medicare Advantage overpayments, an audit published by HHS’ Office of Inspector General June 5 found.  The government watchdog reviewed a sample of diagnosis codes Coventry…

In a featured session at Becker’s 15th Annual Meeting, Joe Vattamattam, co-founder and president of Healthmap Solutions, presented a data-driven case for value-based kidney care. He emphasized the urgent need for earlier intervention, integrated support, and smarter use of AI…

Seventeen percent of initial Medicare Advantage claims are denied, but 57% of originally denied claims are ultimately overturned, according to a study published June 2 in Health Affairs. The study analyzed 270 million claims from 2019 based on data from…

Reps. Alexandria Ocasio-Cortez and Lloyd Doggett have asked U.S. Attorney General Pam Bondi to expand the Justice Department’s reported civil and criminal investigations into UnitedHealth Group to include allegations that the company has engaged in harmful and fraudulent cost-cutting tactics…

During a featured panel discussion hosted by Kyruus Health at Becker’s Spring Payer Issues Roundtable, leaders from Highmark Health, Allegheny Health Network, Corewell Health and UCare came together to dissect one of healthcare’s quietest crises: provider data inaccuracy. The panel…

Deceptive marketing practices, including deepfake AI versions of celebrities like Taylor Swift and Joe Rogan, have led to fraudulent enrollment in ACA plans in recent years, according to a June 5 report from Bloomberg. Primarily in 2022 and 2023, AI-created…

The country’s largest Medicare Advantage carriers are backing significant proposed reforms to billing practices, along with new crackdowns and audits of the plans. CMS Administrator Mehmet Oz, MD, has promised scrutiny of the Medicare Advantage program amid allegations of widespread…

From sweeping federal healthcare policy proposals to upheaval at the nation’s largest insurer, these are the most impactful stories within the health insurance industry since the start of 2025. Medicaid proposals Republicans’ “One Big Beautiful Bill,” passed by the House…

During a featured session at Becker’s 15th Annual Meeting, Jennifer Jones, clinical strategist at Noom Health, urged healthcare leaders to move beyond cost containment and consider how lifestyle interventions — particularly those incorporating GLP-1 medications — can transform clinical and…

Humana and I-SNP carrier Longevity Health have extended their partnership through 2030. First launched in 2023, the collaboration expands special needs health plan offerings for Medicare-eligible individuals living in skilled nursing and senior living facilities. The collaboration currently serves members…