L.A. Care, a publicly operated health plan in California with 2.5 million members, was fined $55 million for failing to authorize members' needed care, ensure timely access to care and address patient complaints, according to The Los Angeles Times.
Payer
From a contract fallout between two of Texas' largest payers and providers to Mayo Health limiting UnitedHealthcare members from making appointments, here are seven recent payer contract disputes and resolutions:
Optum and Cigna's venture arms participated in a $30 million investment in Flume Health, a digital health plan administration platform, according to a news release shared with Becker's.
Three states are each taking their own approach to combat Senior Health Insurance Co. of Pennsylvania's planned rate hikes and benefit cuts.
A New York judge ruled that New York City cannot penalize retirees who decline to participate in a controversial new retiree Medicare Advantage plan provided by Emblem Health and Anthem subsidiary Empire Blue Cross Blue Shield, according to the New…
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The National Association of Accountable Care Organizations is forming a new coalition to educate providers on CMS' new ACO REACH model.
From accusations that Clover Health misled investors to UnitedHealthcare dodging an attempt to reveal negotiated rates with contracted providers, here are five recent legal actions involving payers:
A bill introduced in Congress would require the government to warn adults 60 and older of penalties associated with late Medicare enrollment, according to a March 2 CNBC report.
A judge denied a motion to dismiss a lawsuit out of Nashville, Tenn., that accused Clover Health of misleading investors, according to a Feb. 28 court order.
Building a provider network is challenging. Government regulations are changing, competitors are fast moving, and info sources are scattered. Further, the right network is defined differently by each organization depending on goals and initiatives, member population and more.