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AMA sues MultiPlan, insurers, alleging ‘cartel’ to fix physician prices
MultiPlan, which denies the allegations, has been sued dozens of times over concerns the company is conspiring with health insurers to underpay doctors for out-of-network care.
By Rebecca Pifer Parduhn • Oct. 25, 2024 -
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Employees are asking about GLP-1 coverage. What should employers do?
GLP-1 coverage needs to be holistic to ensure long-term success, experts said.
By Caroline Colvin • Oct. 24, 2024 -
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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 -
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HLTH24‘AI arms race’ underway as payers, providers jockey for upper hand in claims review
Payers currently have a leg up when using AI to review claims, but providers could soon catch up, experts say.
By Susanna Vogel • Oct. 24, 2024 -
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State Medicaid directors concerned about program’s stability: KFF
The presidential election, loss of higher federal funding, inflationary pressures and other challenges are leaving state regulators uncertain about Medicaid’s “new normal.”
By Rebecca Pifer Parduhn • Oct. 24, 2024 -
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Molina ‘beating the odds’ in Medicaid
Conservative planning and continued business growth helped Molina keep an ongoing mismatch between payment rates and member acuity from dinging its bottom line in the third quarter.
By Rebecca Pifer Parduhn • Oct. 24, 2024 -
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Insurer lobby blames government policies for 2025 Medicare Advantage market makeup
The Better Medicare Alliance is warning of disruptions to care for America’s seniors, though MA premiums and major benefits are essentially unchanged next year.
By Rebecca Pifer Parduhn • Oct. 23, 2024 -
Samantha Liss/Healthcare Dive
Centene sues HHS over Medicare Advantage star ratings fall
Centene is emulating other insurers unhappy with how regulators handled quality ratings for 2025. The flurry of complaints is “symptomatic of what appear to be systemic issues” with CMS calculations, Centene said.
By Rebecca Pifer Parduhn • Oct. 23, 2024 -
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HLTH24PBM model is a ‘dead man walking.’ What comes next?
Executives from Amazon, Walgreens, Blue Shield of California and PhRMA weighed in on how to fix the much-scrutinized pharmacy benefit manager model during HLTH 2024.
By Susanna Vogel • Oct. 23, 2024 -
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HLTH24Blue Shield of California partners with Salesforce to automate prior authorization
The collaboration comes amid controversy about claims automation technology. Paul Markovich, CEO of Blue Shield of California, promised to keep a "human in the loop" to oversee any denials.
By Susanna Vogel • Oct. 22, 2024 -
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Humana sues HHS over calamitous Medicare Advantage star ratings decrease
It’s the latest in a string of lawsuits from health insurers scrambling to protect their prized quality scores and the money those ratings represent.
By Rebecca Pifer Parduhn • Oct. 21, 2024 -
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Senate report slams Medicare Advantage insurers for using predictive technology to deny claims
UnitedHealth, CVS and Humana used technology to increase MA prior authorization denials for post-acute services, boosting profits, according to a report from a Senate subcommittee.
By Susanna Vogel • Oct. 21, 2024 -
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CVS replaces CEO Karen Lynch with Caremark head
The struggling healthcare giant also pulled its earnings guidance, citing increased medical cost pressures in health benefits.
By Emily Olsen • Oct. 18, 2024 -
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Elevance lowers guidance on ‘unprecedented’ Medicaid challenges
Executives said the increased costs pressuring its Medicaid business would improve after states updated payment rates to better match member acuity.
By Emily Olsen • Oct. 17, 2024 -
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Blue Cross Blue Shield to pay $2.8B to settle class action provider antitrust case
It's the largest antitrust settlement to date in the healthcare industry, according to law firm Whatley Kallas, which represented the plaintiffs.
By Susanna Vogel • Updated Aug. 22, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth lowers adjusted profit outlook as cyberattack costs rise
The insurer has recorded $2.5 billion in total impacts from the attack through the nine months ended Sept. 30, according to UnitedHealth’s third-quarter earnings.
By Emily Olsen • Oct. 15, 2024 -
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Medicare Advantage star ratings fall again in 2025
About 40% of MA plans with prescription drug coverage will earn four or more stars, a dip from 42% this year, according to data released by the CMS.
By Emily Olsen • Oct. 11, 2024 -
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Fewer than 1 in 5 employer-sponsored plans cover GLP-1s for weight loss
While employers footed the bill for health plan price increases in 2024, they were largely unwilling to give employees access to popular weight loss drugs.
By Susanna Vogel • Oct. 10, 2024 -
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UnitedHealth, CVS push to remove FTC Chair Lina Khan from PBM case
Attorneys argue Khan and two other commissioners are biased against pharmacy benefit managers and should recuse themselves from an ongoing lawsuit against the middlemen.
By Emily Olsen • Oct. 10, 2024 -
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Centene completes sale of management services subsidiary
The sale of Collaborative Health Systems to value-based care firm Astrana Health comes after Centene has divested a number of non-core assets in recent years.
By Emily Olsen • Oct. 9, 2024 -
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CMS to increase oversight on exchange brokers
The agency has reported a growing number of complaints about ACA health plan applications submitted by brokers.
By Emily Olsen • Oct. 7, 2024 -
Courtesy of UnitedHealth Group
UnitedHealth sues CMS over Medicare Advantage star ratings
A handful of plans owned by the nation's largest MA payer are the latest to ask the court to help raise their valuable quality scores.
By Rebecca Pifer Parduhn • Oct. 4, 2024 -
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Texas sues major PBMs, pharma companies over high insulin prices
The litigation comes as pharmacy benefit managers Express Scripts, CVS Caremark and Optum Rx face growing criticism over their role in high drug costs — including a recent lawsuit from the Federal Trade Commission.
By Emily Olsen • Oct. 4, 2024 -
Employers are focusing on plan designs to manage healthcare costs: survey
Nearly half of the employers surveyed said healthcare costs will exceed budget projections this year, WTW said.
By Ginger Christ • Oct. 3, 2024 -
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Medicare tweaks rules for second round of drug price talks
The agency will offer earlier meetings with drugmakers as well as solicit more patient feedback on the process.
By Ned Pagliarulo • Oct. 3, 2024 -
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Humana’s Medicare Advantage dilemma worsens amid precipitous drop in 2025 star ratings
Only 25% of Humana members will be in plans with four stars or above next year, down from 94% this year, the insurer disclosed last week. The downgrade could wipe out Humana’s profits in 2026.
By Rebecca Pifer Parduhn • Oct. 3, 2024
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