Payer: Page 10
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Judge approves $2.8B Blues settlement with providers
The final settlement wraps up 12 years of litigation over Blue Cross and Blue Shield plans’ alleged collusion to lower reimbursement to U.S. providers.
By Rebecca Pifer Parduhn • Aug. 22, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth forms new ‘public responsibility’ board committee
The committee will oversee areas where UnitedHealth has struggled or faced public scrutiny: underwriting and forecasting, regulatory relationships, reputational matters, and M&A.
By Rebecca Pifer Parduhn • Aug. 21, 2025 -
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CVS Caremark fined $290M for Medicare fraud
CVS tried and failed to convince the judge to decrease the penalty. The company plans to appeal the ruling.
By Rebecca Pifer Parduhn • Aug. 20, 2025 -
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Medicare Advantage headwinds dinging member satisfaction: survey
Overall customer satisfaction with MA plans fell 29 points year over year, driven by declining member trust, according to J.D. Power.
By Emily Olsen • Aug. 20, 2025 -
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Elevance loses Medicare Advantage star ratings suit
The Texas judge’s decision — which picked apart Elevance’s argument on mathematical grounds — is expected to cost Elevance $375 million, though the insurer could still appeal.
By Rebecca Pifer Parduhn • Aug. 20, 2025 -
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Judge overturns rule limiting broker payments in Medicare Advantage
Reed O’Connor’s ruling is a setback for smaller MA plans — and efforts to curb predatory marketing to seniors.
By Rebecca Pifer Parduhn • Aug. 20, 2025 -
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Large employers forecast ‘daunting’ 9% hike in healthcare costs next year
Employers surveyed by the Business Group on Health are bracing for the largest annual increase in healthcare costs in more than a decade — a sobering prospect, one expert said.
By Rebecca Pifer Parduhn • Aug. 19, 2025 -
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Sponsored by ZelisWhy this summer is make-or-break for star ratings
More star ratings changes are coming – and your actions this summer are critical for Stars success.
Aug. 18, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth closes $3.3B Amedisys buy after long regulatory battle
The settlement between UnitedHealth, Amedisys and the DOJ cleared the way for the deal to be finalized after a long regulatory delay. Amedisys stopped trading on Nasdaq.
By Rebecca Pifer Parduhn • Aug. 15, 2025 -
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Democrats question Oz on Medicare prior authorization pilot
The CMS plans to trial prior authorization requirements in traditional Medicare. A group of Democrat representatives think that’s a bad idea based on the tool’s track record in Medicare Advantage.
By Rebecca Pifer Parduhn • Aug. 13, 2025 -
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Hospitals prepare for $149B cut to Medicaid state-directed payments
New limits to the program could force hospitals to slash capital spending while bracing for millions of newly uninsured patients.
By Michael Brady • Aug. 12, 2025 -
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Sponsored by Brault Practice SolutionsChoose your words wisely: How ICD-10 choices can impact your bottom line
High-complexity workups, triage-level pay? Don’t let automated down-coding undervalue your work.
Aug. 11, 2025 -
Courtesy of UnitedHealth Group
Deep Dive
UnitedHealth, Amedisys merger appears set to close post-DOJ settlement
The settlement is weaker than at least one antitrust expert expected based on the severity of the DOJ’s concerns. But it means the $3.3 billion merger is very likely to close.
By Rebecca Pifer Parduhn • Aug. 8, 2025 -
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Democrat senators probe UnitedHealth over nursing home care denials
Sens. Ron Wyden and Elizabeth Warren are seeking more information from the beleaguered healthcare behemoth after The Guardian found it was incentivizing nursing homes to reduce hospital transfers.
By Rebecca Pifer Parduhn • Aug. 8, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth and Amedisys reach settlement with DOJ over $3.3B merger
The settlement filed with the Maryland district court on Thursday requires UnitedHealth and Amedisys to divest 164 home health and hospice sites to placate the DOJ’s concerns that the merger is anticompetitive.
By Rebecca Pifer Parduhn • Updated Aug. 7, 2025 -
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ACA plans want to hike premiums by median of 18% next year: KFF
The KFF’s projection is steeper than an older analysis that relied on less complete data. It’s the largest increase that ACA insurers have asked for in more than five years as payers brace for membership turmoil.
By Rebecca Pifer Parduhn • Aug. 7, 2025 -
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The great Medicare Advantage contraction appears set to continue
Insurers plan to keep sacrificing MA growth for profitability next year, after second quarter results for Humana and CVS showed the success of the strategy.
By Rebecca Pifer Parduhn • Aug. 6, 2025 -
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More urban hospitals dually classifying as rural under Medicare: study
Dually classifying allows urban facilities to benefit from rural health programs, even as many rural facilities struggle financially and are at high risk of closure, researchers wrote.
By Emily Olsen • Aug. 6, 2025 -
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More than half of patients report health insurance denied drugs for chronic or rare diseases: poll
The survey also found high rates of alternative funding programs, controversial arrangements in which employers outsource access to pricey specialty drugs to third parties.
By Rebecca Pifer Parduhn • Aug. 5, 2025 -
Samantha Liss/Healthcare Dive
Incoming UnitedHealth CFO steps down from Centene’s board
A clause in Wayne DeVeydt’s new contract prevents him from participating in activities that compete with UnitedHealth. That’s standard for senior executives.
By Rebecca Pifer Parduhn • Aug. 5, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth replaces CFO in another leadership shakeup
Wayne DeVeydt, a healthcare veteran who most recently worked at Bain Capital, will take up the finance chief job on Sept. 2 as the healthcare behemoth faces an array of operational challenges.
By Emily Olsen • Aug. 1, 2025 -
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Cigna beats investor expectations on Evernorth growth
Cigna’s health insurance business is performing within expectations, even as the insurer faces persistently heightened medical costs, executives said.
By Emily Olsen • Aug. 1, 2025 -
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CMS finalizes inpatient payment rate increase for 2026
Medicare finalized inpatient pay rates that are slightly higher than those proposed in April. Hospital groups were pleased with the increases, but said they were still inadequate.
By Sydney Halleman • Aug. 1, 2025 -
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CVS hikes adjusted earnings guidance as Aetna performance improves
The company raised its outlook as many insurers are struggling with elevated medical costs in the second quarter.
By Emily Olsen • July 31, 2025 -
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PBM markets lack competition, new paper finds
The American Medical Association’s research, which found that local PBM markets are highly concentrated, is more fuel for critics of the powerful drug middlemen.
By Rebecca Pifer Parduhn • July 31, 2025
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