Federal prosecutors and auditors are targeting Medicaid behavioral health fraud on multiple fronts, with billions in alleged false claims under scrutiny nationally and two states alone facing audit ...
Albuquerque, N.M.-based Lovelace Health System, owned by Ardent Health, and Health Care Service Corp.’s Blue Cross and Blue Shield of New Mexico have established a four-year agreement to maintain ...
The California Hospital Association has filed a lawsuit against Anthem Blue Cross over a policy that would penalize hospitals when patients receive care from out-of-network physicians, even if the ...
The Connecticut Insurance Department fined Aetna, Cigna, ConnectiCare, UnitedHealthcare and Anthem over alleged mental health parity violations, according to an April 15 department report. The report ...
UnitedHealth Group posted $6.28 billion in profit for the first quarter of 2026, dipping slightly compared to the same period last year. The company released first-quarter earnings April 21, raising ...
Insurers have eliminated 11% of prior authorization requirements across a range of medical services since June, representing 6.5 million fewer prior authorizations for members, according to an ...
CMS is raising Medicare Advantage payments by 2.48%, or more than $13 billion, according to its finalized 2027 rate announcement. The agency said April 6 that when estimated risk score trends in MA ...
The Blue Cross Blue Shield Association submitted a wide-ranging letter to CMS on March 30 in response to the agency’s information request on its Comprehensive Regulations to Uncover Suspicious ...
The Maryland Insurance Administration issued Cigna an $80,000 fine and is requiring the insurer to stop automatic downcoding under a recent policy, according to a March 13 letter. Cigna’s evaluation ...
A federal magistrate judge in Minnesota has ordered UnitedHealth Group to produce a wide range of documents in an ongoing lawsuit accusing the insurer of using an AI algorithm to wrongfully deny ...
Frisco, Texas-based Magellan Health has entered into an agreement to be acquired by Madison Health Group, according to a Feb. 13 LinkedIn post from Magellan. Magellan Health CEO Caroline Carney, MD, ...
Optum has launched a pair of AI-driven prior authorization products, one designed to speed up submissions on the provider side and another to accelerate clinical reviews for payers. The ...
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