Finances
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Sponsored by ModMedHow to slash the multi-billion dollar RCM Tax™: Leveling the playing field against payer AI
Discover how proactive clinical-financial workflows can protect your practice's bottom line.
By Rob Ware, Senior Vice President & General Manager at ModMed • Sept. 28, 2026 -
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Sponsored by Elevance HealthThe hidden cost of disconnected care
Disconnected care can be a major – and often overlooked – driver of unnecessary healthcare costs.
By Mark Kaye, Chief Financial Officer and Executive Vice President, Elevance Health • Sept. 21, 2026 -
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Federal watchdog accuses Humana, UnitedHealthcare Medicare Advantage plans of upcoding
Newly released HHS OIG audits of HumanaChoice and UnitedHealthcare of Wisconsin found both plans frequently exaggerated the health needs of their members, generating almost $180 million in overpayments over two years.
By Rebecca Pifer Parduhn • Sept. 17, 2026 -
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Johnson & Johnson requires providers to share claims data to get 340B discounts
The drugmaker is the latest to impose a reporting requirement on 340B providers, saying stricter guardrails are needed to prevent duplicative discounts.
By Rebecca Pifer Parduhn • Sept. 14, 2026 -
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Half of Medicare Advantage stars thresholds harder to reach in 2027
The CMS has released draft star ratings, including the thresholds for reaching those ratings, to plans. The grading sheet got stricter, which doesn’t bode well for insurers, one MA expert said.
By Rebecca Pifer Parduhn • Sept. 10, 2026 -
Courtesy of UnitedHealth Group
UnitedHealthcare expects to be ‘very competitive’ in Medicare Advantage next year, CFO says
The insurer is still working on strategies to ensure its MA markets remain as profitable as possible, but it’s confident in its posture heading into 2027 open enrollment, Wayne DeVeydt said Wednesday.
By Rebecca Pifer Parduhn • Updated Sept. 10, 2026 -
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Q&AFinance is ‘leaning in’ to manage healthcare costs, WTW exec says
CFOs are increasingly partnering with human resource executives to help trim rising healthcare costs, WTW’s Tim Stawicki says.
By Maura Webber Sadovi • Sept. 2, 2026 -
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HaloMD says No Surprises is lowering spending on emergency care. Researchers aren’t convinced.
The NSA has saved at least $1 billion on out-of-network emergency medical spending, according to the billings firm’s new study. But HaloMD’s methodology leaves something to be desired, independent experts said.
By Rebecca Pifer Parduhn • Sept. 2, 2026 -
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Medicare spent hundreds of millions of dollars on ineligible drugs, audit finds
Shoddy CMS oversight is to blame, and the agency needs to do better, the HHS Office of the Inspector General said. The CMS concurred.
By Rebecca Pifer Parduhn • Sept. 2, 2026 -
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Florida attorney general sues PBMs Express Scripts, Prime over alleged price fixing
A deal between rival drug middlemen Prime Therapeutics and Express Scripts depressed reimbursement rates for pharmacies, according to the new complaint. It’s the latest legal challenge against the partnership.
By Jill Hughes • Aug. 31, 2026 -
Samantha Liss/Healthcare Dive
Centene taps Fannie Mae executive as CIO
Bradley Bolivar is taking the reins of Centene’s IT strategy as artificial intelligence drives a sea change for how insurers do business.
By Rebecca Pifer Parduhn • Aug. 31, 2026 -
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Specialty providers refute hefty Georgetown estimates of No Surprises costs
Researchers estimate that independent dispute resolution has created $22 billion in unnecessary spending. But that estimate is flawed, argue associations representing anesthesiologists, radiologists and ER doctors.
By Rebecca Pifer Parduhn • Aug. 28, 2026 -
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Humana-owned Villages Health agrees to $542M settlement for overbilling Medicare
The Central Florida provider manufactured fake diagnosis codes for its Medicare Advantage patients from 2020 to 2024, the DOJ said. Humana bought The Villages Health last year.
By Rebecca Pifer Parduhn • Aug. 27, 2026 -
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Sword Health to acquire Headspace
The all-cash deal is expected to close next month, after which Headspace’s wellness services will live under the same roof as Sword's virtual care platform, according to a filing with Massachusetts regulators.
By Jill Hughes • Aug. 26, 2026 -
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Employers face ‘existential reckoning’ as health costs surge
Employers are expecting a median 9.2% increase in medical spending next year, according to a new survey. But they’ve underestimated actual cost growth for the past three years, so even that figure may be too optimistic.
By Rebecca Pifer Parduhn • Aug. 26, 2026 -
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No Surprises dispute resolution has generated $22B in extra costs, research finds
Accelerating dispute volumes and sky-high award amounts are inflating how much independent dispute resolution is costing the U.S., according to new Georgetown research. Patients could pay the price with higher premiums.
By Rebecca Pifer Parduhn • Aug. 26, 2026 -
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‘A game changer’: UHS closes $835M Talkspace acquisition
Bringing Talkspace on board should expand behavioral health services for UHS’ existing patients, while ushering more consumers through the health system’s doors, UHS CEO Marc Miller said.
By Rebecca Pifer Parduhn • Aug. 17, 2026 -
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Insurers want to hike small businesses’ premiums by 14% next year: KFF
It’s becoming harder for small employers to offer insurance coverage, and another year of double-digit premium increases won’t help. Insurers say their hands are tied.
By Rebecca Pifer Parduhn • Aug. 7, 2026 -
Courtesy of Hinge Health
Hinge Health expands into gastrointestinal care with $105M acquisition
Hinge is purchasing Cylinder Health in a “logical extension” of the San Francisco-based company’s business, one analyst commented.
By Rebecca Pifer Parduhn • Aug. 6, 2026 -
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Complete Health to pay $14M to settle Medicare Advantage fraud allegations
The value-based primary care provider submitted false diagnosis codes to the CMS for three years, inflating its reimbursement by millions of dollars, according to the DOJ.
By Rebecca Pifer Parduhn • Aug. 5, 2026 -
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CVS triples net income thanks to booming health plan profitability
“There’s not much more to say for CVS’ 2Q other than... wow,” one analyst commented. CVS also announced a new GLP-1 deal with Eli Lilly.
By Rebecca Pifer Parduhn • Aug. 5, 2026 -
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Hospitals feel the pinch as more patients lose insurance
Half a year after enhanced Affordable Care Act subsidies expired, hospitals say more patients are going uninsured. That’s starting to drag their finances.
By Sydney Halleman • Aug. 4, 2026 -
Permission granted by Teladoc Health
Teladoc lowers revenue outlook amid BetterHelp demand headwinds
Demand for the mental health unit’s insurance offering accelerated faster than expected, eating into its cash pay business. The quarter marked an “unfortunate setback” for BetterHelp, one analyst said.
By Emily Olsen • July 30, 2026 -
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Cigna’s profits jump thanks to employer-sponsored plans
Cigna increased its 2026 earnings outlook following the second quarter, unbothered by inflated costs for surprise billing dispute resolutions reported by its peer UnitedHealth.
By Rebecca Pifer Parduhn • July 30, 2026 -
Illustration: Xavier Lalanne-Tauzia for Industry Dive
UHS flags rising uninsured volumes in Q2
“Virtually everyone” losing Affordable Care Act coverage is going uninsured, one UHS executive said. The hospital operator expects to lose $10 million more than expected as a result this year.
By Sydney Halleman • July 29, 2026
