Payer

UnitedHealthcare received $42 million in fraudulent claims over four years from a South Florida clinic, the Justice Department announced Feb. 10. 

America's Health Insurance Plans' board of directors and CMOs issued guidance to payers on protecting patient data as the landscape continues to adopt virtual tools and solutions. 

Members are not taking advantage of requirements that payers must cover at-home COVID-19 tests, and signs point to reimbursement woes as a key contributing factor, according to TMJ4. 

While UnitedHealthcare dominated 2021 in terms of revenue among health insurers, it's a tight financial race between many of the country's other top payers. 

More than 90 percent of physicians reported that prior authorization delays care, and nearly one-fourth say those delays have led to patient hospitalizations, according to a Feb. 10 American Medical Association survey. 

Maternity and neonatal care company ProgenyHealth anticipates five trends will dominate the way payers cover and support mothers and caregivers.

Blue Shield of California is collaborating with community partners to launch a new health equity initiative targeting mothers.

Humana Specialty Pharmacy arm announced Feb. 8 that it would begin offering members Tagrisso and Lenvima, two drugs for cancer treatment.

Patrick Phillips, CEO of Medicare Advantage technology company Cavulus, predicted in 2019 that the Medicare Advantage landscape would be disrupted by start-ups — a vision that is a reality three years later. 

CVS Health saw COVID-19 expenses drop and government business rise, resulting in an 8.7 percent year-over-year increase in revenue, according to the company's year-end earnings report.