Payers have faced state penalties in 2024 for slow reimbursements, improper claims denials, or the sale of unapproved products. 12 recent examples of payers fined or agreeing to settlements with ...

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HHS' Office of Inspector General has issued a special fraud alert about the risks of fraud and abuse in certain marketing and compensation arrangements related to Medicare Advantage. The December ...

Sacramento, Calif.-based Sutter Health has named Aparna Abburi as senior vice president of population health and health plan services and CEO of Sutter Health Plan. Ms. Abburi previously held ...

UnitedHealth Group and home health company Amedisys have agreed to extend the deadline for a planned $3.3 billion merger due to a legal challenge by the Department of Justice. In a Dec. 26 regulatory ...

Blue Cross Blue Shield companies have the largest market share among commercial insurers in the majority of states, according to the American Medical Association's annual "Competition in Health ...

Georgia will award Medicaid contracts to four Medicaid managed care organizations. According to a notice published Dec. 2, the agency plans to grant Medicaid contracts to Humana, CareSource, Molina ...

California has the highest number of individuals with Medicare Part D coverage, while Washington, D.C. has the lowest amount, according to KFF. The 2024 data from CMS includes standalone Part D and MA ...

2024 was a tumultuous year for Medicare Advantage. Increased government scrutiny, tighter CMS regulations, reduced base payments and rising healthcare costs are putting pressure on the program.

Medicare Advantage plans must comply with new network adequacy and health equity standards in 2025. Here are five policy changes taking effect in 2025: CMS will require Medicare Advantage plans to ...