Former Tuomey exec settles for $1M in false claims case

Ralph J. Cox III will also be excluded for four years from participating in federal healthcare programs, including providing management or administrative services paid for by federal healthcare programs. 

By Jeff Byers • Sept. 28, 2016

3 technologies payers are trying to figure out

Insurers are looking to tech to navigate the shift to value-based care and the consumerization of healthcare. 

By Luke Gale • Sept. 28, 2016

Patient ID mix-ups still a 'significant' problem, new analysis finds

Medical record errors occur in all healthcare settings and at every point in the patient journey.

By Meg Bryant • Sept. 27, 2016

Report: Top pay soars at Health Care Service Corp. amid ACA losses

The company's former CEO reportedly made more than $16 million in 2015 despite corporate net losses of $66 million.

By Heather Caspi • Sept. 27, 2016

Tennessee BlueCross BlueShield cuts ACA offerings

The move has added fuel to the fire around insurer abandonment of the ACA marketplaces.

By Heather Caspi • Sept. 27, 2016

Trump healthcare policy estimated to cut coverage for 20M Americans by 2018

Clinton's proposals, meanwhile, are expected to increase insurance coverage somewhere within the range of 400,000 to 9.6 million.

By Heather Caspi • Sept. 26, 2016

Average Medicare Advantage premium to drop $1.19 in 2017

Enrollees in Medicare Advantage plans can expect to see more supplemental benefits next year, CMS says.

By Meg Bryant • Sept. 23, 2016

CA insurance commissioner advocates public option

Critics say private insurers could exit the California exchange, rather than compete with a public option.

By Meg Bryant • Sept. 23, 2016

Bill seeks to limit Medicare beneficiaries' out-of-pocket spending

The legislation would provide a cap similar to those for Medicare Advantage and most private plans.

By Heather Caspi • Sept. 22, 2016

DOJ filing reveals how nasty Anthem & Cigna's bickering has gotten

The pair's contentious correspondence could spell the end for the deal.

By Heather Caspi • Sept. 22, 2016

Global analysis rates US 'moderate' in progress toward value-based healthcare

Points from the report could shed light on the path forward for the U.S.

By Heather Caspi • Sept. 22, 2016

Aetna, others appeal PA's estimated $5B Medicaid contract awards

Managed-care companies continue to vie for the contracts worth $5.4 billion in annual revenue.

By Heather Caspi • Sept. 21, 2016

ACO inside report details challenges of 'regulatory headwinds'

Regulatory "tweaks" could determine whether providers stay with the MSSP over the long haul, Aledade contends.

By Heather Caspi • Sept. 21, 2016

MACRA is coming: A quick once-over before the final rule

MACRA is set to make significant changes to provider payments and reporting requirements. Will these changes be effective and will providers even notice? 

By Luke Gale • Sept. 21, 2016

AHIP mobilizes industry opposition to public option

Though there is no imminent threat, support for the concept has leaped forward.

By Heather Caspi • Sept. 21, 2016

NAHC pays $30M to settle improper billing charges

The false billings were submitted to Medicare and TRICARE for unnecessary rehab services.

By Meg Bryant • Sept. 20, 2016

Study highlights relative affordability of ACA vs. employer premiums

The findings provide perspective to frame concerns over premium increases in the ACA marketplaces. 

By Heather Caspi • Sept. 20, 2016

CMS bundled payment evaluation 'encouraging' yet inconclusive

Only time – and more data – will tell what the true savings and quality impacts will be. 

By Heather Caspi • Sept. 20, 2016

North Carolina levies record fine against BCBS over IT fiasco

Despite the size of the fine, it pales in comparison to the insurer's other expenses in cleaning up its mess.

By Heather Caspi • Sept. 19, 2016

Aetna claims confidence during merger trial preparation

The health insurance giant believes it has a strong case but it is preparing for the decision to go either way.

By Heather Caspi • Sept. 19, 2016

Centene plans to expand participation in Arizona exchange

The insurer may be the only one offering health plans on the ACA exchange in Maricopa County next year.

By Luke Gale • Sept. 16, 2016

GOP Senate proposal addresses lack of options on exchanges

There are dueling ideas on the Senate floor for dealing with lack of competition on the insurance exchanges.

By Luke Gale • Sept. 16, 2016

Employers shift costs with 12% surge in deductibles

The move has helped hold down premiums, but at what other expense?

By Heather Caspi • Sept. 15, 2016

House committees detail harsh co-op, marketplace lessons learned

While the marketplace may be on course for a correction, it's less certain whether any co-ops will remain to participate.

By Heather Caspi • Sept. 15, 2016

Census: ACA adds an assist to insure more Americans

The percentage of uninsured Americans dipped from 2014 to 2015 to a total of 9.1% of the population under age 65.

By Heather Caspi • Sept. 14, 2016