Payer

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…

The Urgent Need to Revamp Utilization Management Practices The healthcare industry is at a critical juncture, grappling with inefficient Utilization Management (UM) systems that have long been a source of frustration for patients, providers, and payers alike. Originally designed to…

UnitedHealth Group has cancelled the performance-based restricted stock units previously granted to its former CEO Andrew Witty. The stock units were given to Mr. Witty in February, but he agreed to the cancellation after departing the company last month for…

Outpatient care and pharmacy costs were the main drivers of the 6.2% increase in healthcare expenses for a family of four from 2024 to 2025, according to the latest Milliman Medical Index. Milliman has tracked healthcare costs for 20 years and…

Medica is expanding into the St. Louis region with new network partnerships that include SSM Health and Mercy. The company’s commercial plans include ACA-funded small group, level-funded, fully insured and self-insured large group options. Medica also operates in the Medicaid…

Following a tumultuous period for UnitedHealth Group, new CEO and board chair Stephen Hemsley addressed investors on June 2, acknowledging the company’s recent shortcomings and detailing his plan to restore the high performance that investors and customers expect moving forward.…