Payer: Page 2
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Judge dismisses Medicaid fraud suit against Centene’s board
A Pennsylvania pension fund had argued Centene board members failed in their oversight responsibilities and ignored red flags about a Medicaid overbilling scheme.
By Emily Olsen • July 17, 2024 -
Permission granted by Elevance Health
Elevance hits $2.3B in profit but trims long-term guidance
Elevance beat Wall Street expectations in second-quarter results posted Wednesday, despite steep Medicaid membership losses that are affecting revenue forecasts.
By Rebecca Pifer • July 17, 2024 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/Provider relationships
As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
Courtesy of UnitedHealth Group
UnitedHealth’s cyberattack response costs to surpass $2.3B this year
The healthcare giant’s new estimate is roughly $1 billion higher than previous forecasts as the cyberattack on subsidiary Change Healthcare continues to hamper its profit outlook.
By Rebecca Pifer • July 16, 2024 -
Surprise BillingCMS’ first No Surprises audit targets Aetna, finds some noncompliance
The findings are a “big deal,” according to one expert, as CVS’ health insurer didn’t follow some “major requirements that are essential to ensuring that the IDR process runs smoothly.”
By Rebecca Pifer • July 12, 2024 -
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Employers say they’ll double down on healthcare benefits despite rising costs
Companies are split on how to pay for the rising expense, but a slight plurality said in a Mercer survey it was unlikely they’d shift costs onto workers.
By Emilie Shumway • July 11, 2024 -
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CMS proposes 2.9% cut to physician pay for 2025
Regulators said Medicare’s budget neutrality requirement is to blame for the reduction, which was quickly decried by provider groups. However, it’s likely Congress will step in to mitigate the drop.
By Rebecca Pifer • July 11, 2024 -
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Federal Trade Commission to sue three largest PBMs: WSJ
Antitrust regulators are poised to file suit against CVS Caremark, Express Scripts and Optum Rx over how they negotiate discounts for drugs, including insulin, according to the report.
By Rebecca Pifer • July 10, 2024 -
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Judge pauses CMS rule capping compensation for Medicare Advantage brokers
Texas Judge Reed O’Connor’s decision suggests he could overturn at least part of the rule, which is meant to curb predatory plan marketing to seniors.
By Rebecca Pifer • July 10, 2024 -
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Medicare proposes 2.6% bump to hospital outpatient pay next year
The sweeping payment rule also solidifies continuous eligibility requirements for children in Medicaid and CHIP, and holds hospitals to higher obstetric care delivery standards in a bid to improve maternal mortality.
By Rebecca Pifer • July 10, 2024 -
Alex Wong via Getty Images
CMS revised Medicare Advantage star ratings. Here’s which payers benefited.
More than 60 Medicare Advantage health plans from 40 insurers have received a higher star rating for 2024, according to a Healthcare Dive analysis.
By Rebecca Pifer • July 9, 2024 -
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FTC slams pharmacy benefit managers in first report from ongoing investigation
On Tuesday, regulators updated the public on their almost three-year-old inquiry into PBMs’ anticompetitive business practices. The report is not positive for the drug middlemen, which immediately criticized it as one-sided.
By Rebecca Pifer • July 9, 2024 -
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OpinionMental health benefits at work are getting better. Here’s how we can go further.
More employers than ever are focusing on mental health benefits. Congress must invest more and act soon to reauthorize telehealth extensions before it’s too late, argues the director of health policy at the U.S. Chamber of Commerce.
By Anna Vredenburgh • July 3, 2024 -
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Medicaid redeterminations1 in 8 enrollees exited Medicaid during redeterminations in 4 Southern states: study
The survey, which included low-income people in Arkansas, Kentucky, Louisiana and Texas, found about half of those who were no longer enrolled in Medicaid were uninsured in late 2023.
By Emily Olsen • July 3, 2024 -
Courtesy of UnitedHealth Group
UnitedHealth, Amedisys agree to sell clinics to get merger across finish line
The divestiture will only go through if UnitedHealth and Amedisys complete their merger, which was announced last summer but has been held up amid scrutiny from the Department of Justice.
By Rebecca Pifer • July 2, 2024 -
Courtesy of UnitedHealth Group
Optum Rx reaches $20M settlement with Justice Department over opioid prescribing
The UnitedHealth pharmacy benefit manager did not have to admit guilt as part of the settlement, which amounts to a minuscule fraction of its annual revenue.
By Rebecca Pifer • June 28, 2024 -
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Arkansas sues Optum, Express Scripts over role in opioid epidemic
Pharmacy benefit managers have largely avoided the brunt of public blame for the deadly opioid crisis. Arkansas’ lawsuit brings the drug middlemen back to the forefront of the controversy.
By Rebecca Pifer • June 25, 2024 -
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Appeals court upholds ACA’s preventive services mandate, but opens door to future challenges
The Fifth Circuit Court of Appeals’ decision Friday is a win for the upwards of 150 million people that receive health insurance through their employers. However, it paves the way for future lawsuits from opponents of the ACA.
By Rebecca Pifer • June 24, 2024 -
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States using unwinding lessons to improve Medicaid: KFF
Medicaid unwinding has been less than perfect. However, the process has helped states expand Medicaid eligibility to more people and streamline enrollment and outreach, according to a new survey.
By Rebecca Pifer • June 21, 2024 -
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Uninsured rate expected to hit 8.9% over next decade, CBO finds
New government projections chart a rise in the nation’s uninsured rate as policies that swelled healthcare coverage during the coronavirus pandemic expire.
By Rebecca Pifer • June 18, 2024 -
Courtesy of Amazon
Amazon expands drug subscription program to Medicare members
RxPass is now available to more than 50 million Medicare members after Amazon brought it into compliance with the program’s regulatory standards.
By Rebecca Pifer • June 18, 2024 -
Foremniakowski via Getty Images
Change Healthcare cyberattackBiden administration gives providers grace period to open surprise billing arbitration
Because of the cyberattack on Change Healthcare earlier this year, providers say they’re having difficultly getting the necessary information from plans required to kick off the dispute resolution process.
By Rebecca Pifer • June 17, 2024 -
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Lawmakers promise to stop kicking the can on Medicare solvency
The House Budget Committee met Thursday and said they’d take action to restore Medicare’s financial footing, though the hearing was light on specifics.
By Rebecca Pifer • June 14, 2024 -
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CMMI’s savings record sparks concern among lawmakers
Republicans at a House subcommittee hearing chided the innovation center for increasing federal spending, even as CMMI’s director said each tested model has resulted in valuable learnings.
By Emily Olsen • June 14, 2024 -
Alex Wong via Getty Images
CMS recalculates Medicare Advantage star ratings in major win for insurers
The redo comes after regulators lost two court cases over the methodology used to determine 2024’s quality ratings and should result in hundreds of millions of dollars in additional bonuses to plans.
By Rebecca Pifer • June 14, 2024 -
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Cardiovascular conditions now the second-highest reimbursement category, Sun Life says
Cost of cardiovascular conditions is up 33% — “higher than we would expect given medical inflation,” the insurance provider said.
By Emilie Shumway • June 13, 2024
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