Montana has clawed back more than $23 million in fraudulent claims after PacificSource flagged more than 200 suspicious ACA enrollments tied to as much as $54.7 million in unjustified claims. A state investigation identified a scheme in which out-of-state individuals…
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Alameda Alliance for Health, a county-organized Medicaid managed care plan serving more than 400,000 members in Alameda County, Calif., is bracing for a potential 40% to 45% reduction in membership over the next three years as federal Medicaid cuts and…
Alliance of Community Health Plans President and CEO Ceci Connolly sees momentum around risk adjustment reform picking up. “We see this administration taking very seriously the concerns over wide gaps in risk adjustment payments — gaps that are far outside…
From Optum launching a pair of prior authorization tools to UnitedHealthcare projecting it will lose up to 2.8 million members in 2026, here are 10 updates on UnitedHealth Group and its subsidiaries that Becker’s has reported since Jan. 14: 1.…
CVS Health’s approximately 9,000 community pharmacies began accepting TrumpRx discount cards Feb. 6. The cards offer savings on certain medications for eligible patients, as determined by drugmakers, according to a Feb. 6 CVS news release. Patients can present printed discount…
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UnitedHealth’s Optum identified $1.7 billion in potential savings if Minnesota would remedy ambiguity in its Medicaid policies, according to a Jan. 31 from the company. As of October, the Minnesota Department of Human Services had contracted with Optum to analyze claims…
Elevance Health bid on 11 national accounts in competing Blue Cross Blue Shield markets last year and won nine of them, the company said on its 2025 earnings call with investors, offering the first look at how a landmark antitrust…
About 4,000 Maryland Health Benefit Exchange customers “were mistakenly notified” of 2026 auto-renewal for CareFirst BCBS coverage, the insurer told Becker’s Feb. 5. CareFirst attributed the error to a “data synchronization issue” with the marketplace and said these individuals did…
Molina Healthcare will exit the Medicare Advantage Part D business in 2027, the company announced alongside its fourth quarter and full year 2025 earnings report published Feb. 5. The MAPD product represents approximately $1 billion in annual premiums. Molina said…
The Cigna Group’s board of directors on Feb. 5 declared a per-share cash dividend of $1.56 to be paid on March 19. The dividend will be paid to shareholders of record as of the close of business on March 5.…