CMS estimated there were $28.83 billion in improper payments for Medicare fee for service in fiscal 2025. Compared to 2024 reporting, that value is down from $31.7 billion. “While CMS’ improper payment reporting programs are designed to protect the integrity…
Payer
Bloomington, Minn.-based HealthPartners launched its copay-only health plan, Simplica NextGen Copay, this year. The plan sets prices for in-network care without a deductible or coinsurance. Moe Suleiman, senior vice president of commercial business, and Maggie Helms, senior vice president, chief…
New Mexico has seen the biggest increase in ACA enrollment from 2025 to 2026, while North Carolina has seen the largest decrease, according to KFF. The ranking below uses preliminary CMS data comparing similar periods during the 2025 and 2026…
Alignment Healthcare has California roots, but its CEO, John Kao, is confident about planting seeds for growth elsewhere. Mr. Kao weighed in on Alignment’s strategy Jan. 14 during the J.P. Morgan 2026 Healthcare Conference in San Francisco. Just days before,…
The ACA open enrollment period for 2026 ended Jan. 15, as a tumultuous battle over enhanced subsidies continues. The possible return of subsidies may no longer mean much for this year. Here are six things to know about how the…
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Blue Cross Blue Shield of Vermont backed a campaign, called Vermont Affordable Care, focused on comparing pricing policies at independent facilities and academic centers. The initiative — also led by St. Albans, Vt.-based Northwestern Medical Center, Colchester, Vt.-based Green Mountain…
Oakland, Calif.-based Kaiser Permanente has agreed to pay $556 million to resolve allegations that it violated the False Claims Act by submitting invalid diagnosis codes for Medicare Advantage enrollees to obtain higher payments from the federal government. According to the…
L.A. Care Health Plan is laying off 225 employees by March 13. The insurer told Becker’s the move affects 3% of its workforce and was driven by federal and state Medi-Cal budget reductions, which subsequently led to organizational restructuring. Impacted…
From a Senate report finding the company used “aggressive strategies” to secure higher-paying Medicare Advantage diagnoses to Optum beginning a review of Minnesota Medicaid claims, here are 10 updates on UnitedHealth Group and its subsidiaries that Becker’s has reported since…
Clover Health reported 53% year-over-year growth in Medicare Advantage PPO membership, according to a Jan. 14 news release from the insurer. The growth translated to roughly 153,000 members, building on positive traction from 2025. The company is now expecting to…