Payer

Centene's Fidelis Care has reached a $7.6 million settlement agreement with New York Attorney General Letitia James for billing Medicaid for services provided by an individual convicted of a crime.

Seniors are given the opportunity to switch Medicare Advantage plans annually, but some evidence suggests that committing to multi-year contracts could lead to better health outcomes.

Anthem Blue Cross Blue Shield is requesting payments from some providers it alleges falsified patients' medical records when prescribing Ozempic, Bloomberg reported Sept. 12. 

Bonus payments to Medicare Advantage plans will decline by around 8% in 2024 compared to 2023, according to a report from KFF. 

UnitedHealthcare and Humana are expected to collectively receive 50% of total Medicare Advantage star bonus payments in 2024, while Kaiser Permanente is expected to collect the highest average bonus per enrollee ($516), according to a Sept. 11 analysis from KFF.

Aetna is facing a class-action lawsuit alleging the insurer improperly denied gender-affirming care. 

CMS is suspending new enrollment for a Centene Medicare Advantage subsidiary in Missouri after the company failed to meet the required medical loss ratio for three years in a row.

St. Louis-based Mercy has notified Anthem Blue Cross Blue Shield that it will go out-of-network with the insurer in Missouri if a new agreement is not reached by Jan. 1, 2025. 

UnitedHealthcare offers the best desktop digital experience among major insurers, and Anthem BCBS plans offer the best mobile app experience, according to new research from Corporate Insight shared with Becker's.

Centene expects rising Medicaid expenses to hurt its third-quarter earnings.