CMS is seeking input on whether its risk adjustment system disadvantages smaller Medicare Advantage plans, and one regional plan CEO says the answer is an emphatic yes. In its 2027 proposed MA rule, ...

CMS has proposed two new models aimed at curbing Medicare drug spending by linking payments to international benchmarks. The proposals — GUARD for Part D drugs and GLOBE for Part B — are the latest in ...

A group of 33 NorthStar anesthesia providers filed a lawsuit against Aetna and Cigna over an alleged $4.1 million in No Surprises Act underpayments, according to Dec. 8 filings in Connecticut’s U.S.

UnitedHealthcare is delaying a coverage policy that would have sharply restricted remote physiologic monitoring services for most chronic conditions. The policy, which had been scheduled to take ...

Humana’s Louisiana business received at least $10.5 million in Medicare Advantage overpayments in 2017 and 2018, according to an audit report from HHS’ Office of Inspector General. The audit, ...

CMS is launching its long-term enhanced accountable care organization design, or LEAD, model at the end of 2026, following the conclusion of the ACO realizing equity, access and community health model ...

Minnesota is rehabilitating UCare, according to a Dec. 17 court filing. The state will take over the insurer’s assets and finances. While providers cannot collect payment from UCare during this time, ...

UnitedHealth Group has released findings from multiple independent reviews of its business practices following a June pledge from CEO Stephen Hemsley to conduct a transparent and comprehensive ...

A healthcare experience that offers an integrated, holistic approach is more critical than ever. It transcends traditional healthcare approaches by emphasizing the importance of putting the patient at ...

Throughout 2025, health insurance leaders have weighed in on the role AI should play in the industry, from advancing operational efficiencies to integrating with consumer-facing technology. Here are ...

Providers win about 80% of “No Surprises Act” cases that reach arbitration, according to Elevance Health Public Policy Institute research published Dec. 10 in Inquiry: The Journal of Health Care ...

Traditional Medicare could have saved $7 billion from 2019 to 2023 across four services had it mirrored Medicare Advantage’s utilization rates and fraud strategies, according to a December Berkeley ...