Payer

A New Jersey-based company has agreed to pay more than $11.3 million to settle False Claims Act allegations arising from fraudulently reported call center performance metrics and fraudulent claims to the South Carolina Department of Health and Human Services.

UnitedHealthcare is asking a federal court to prevent CMS from downgrading its Medicare Advantage star ratings based on one phone call. 

Centene's Ambetter Health individual plans will expand to 60 new counties in 2025. 

The USP Drug Classification PLUS is an offering from USP that provides online, interactive access to the USP Drug Classification (an independent drug classification of FDA-approved drugs, organized by categories and classes) with:

The percentage of Humana Medicare Advantage members enrolled in plans rated 4 stars or higher for 2025 has dropped significantly, which is expected to negatively affect 2026 revenues.

Blue Shield of California will purchase Fresenius Kabi's Humira biosimilar directly from the manufacturer, a deal that will cut costs and improve patient adherence, the insurer said. 

Opioid use disorder (OUD) continues to impose a financial burden on the U.S. health care system, with direct health care costs estimated at $63 billion annually. A significant portion of these costs stem from hospitalizations related to withdrawal management and…

Elevance is planning to expand its operations in Indianapolis by investing $11.9 million in two sites in the city, Inside Indiana Business reported Sept. 30. 

Premera Blue Cross will no longer offer Medicare Advantage plans in 2025. 

In 22 states and Washington, D.C., there will be fewer Medicare Advantage plans available in 2025 than in 2024, according to CMS data.