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California fines Kaiser Permanente health plan for violating enrollee confidentiality
California's Department of Managed Healthcare has fined Kaiser Permanente $450,000 for sending mailings with enrollees' private health information to incorrect addresses. -
Humana joins UnitedHealth in rising medical cost warning
Humana is anticipating its medical loss ratio will be at the top end of its full-year projected range of 86.3 percent to 87.3 percent, according to a June 16 SEC filing. -
Alliance of Community Health Plans pitches cap on Medicare Advantage marketing spending, broker payments
The Alliance of Community Health Plans is proposing a set of policies aimed at curbing misleading marketing in Medicare Advantage. -
How CVS, Walgreens are the front door to Medicaid redeterminations
The nation's retail pharmacy giants are playing an important role in Medicaid redeterminations through payer-agnostic outreach and education initiatives aimed at customers and employees in all 50 states. -
What 9 leaders are saying about Medicaid coverage losses
More than 1 million people have been disenrolled from Medicaid coverage, according to June 12 data from KFF. -
Cigna in the headlines: 7 recent updates
Cigna is delaying a prior authorization policy and pursuing legal action to keep one of its former executives from joining CVS Health. -
CMS: Private insurance spending to increase in 2023, 2024; slow in 2025 onward
CMS is projecting a 7.7 percent increase in private health insurance spending in 2023, driven by an increase in utilization and rising prices of medical care. -
80% of privately insured adults rate their coverage positively: 10 things to know
Four in 5 adults with employer-sponsored insurance rated their coverage positively, but many also reported having problems with their insurance in the past 12 months, according to a survey from KFF. -
9 prior authorization updates
From UnitedHealthcare backing off a gastroenterology endoscopy policy, to the American Medical Association raising concerns about the use of artificial intelligence, here are nine updates on prior authorization Becker's has reported since May 11: -
AMA urges more oversight of AI in prior authorization
The American Medical Association is raising concerns about the use of artificial intelligence to review claims for prior authorization. -
Florida hasn't taken up any of CMS' Medicaid redetermination waivers
Just two states — Florida and Montana — have not taken up any temporary waivers from CMS designed to simplify Medicaid renewals. -
Optum in the headlines: 8 updates
From pitching a merger with Amedisys, to naming a president of its Global Advantage division, here are eight updates on Optum that Becker's reported since May 17. -
Disenrollments will decrease Medicaid spending in 2024, CMS analysis finds
Medicaid disenrollments will drive a total decrease in spending in 2024, even as spending per beneficiary is set to increase, according to new CMS data. -
Aetna defends its Medicare Advantage contract for NYC retirees
Aetna is seeking to intervene in a lawsuit filed by retired New York City employees seeking to block the payer's Medicare Advantage contract with the city from taking effect. -
Medical costs are up, UnitedHealthcare exec says
UnitedHealthcare is seeing rising utilization as more older adults seek out services they delayed during the COVID-19 pandemic, Barron's reported June 14. -
Empire BlueCross BlueShield rebranding as Anthem
Empire BlueCross BlueShield and Empire Blue Cross will rebrand as Anthem Blue Cross Blue Shield and Anthem Blue Cross in 2024. -
Medicare Advantage overpayments could exceed $75B in 2023, study finds
Medicare Advantage plan enrollees have lower expenses than those with similar risk scores who remain in traditional Medicare, but payments to the program are based on traditional Medicare, according to a whitepaper from researchers at the University of Southern California in Los Angeles. -
Fraud scheme enrolled homeless individuals in ACA plans they couldn't afford
Potentially hundreds of homeless individuals in Florida were signed up for ACA exchange plans they could not afford in a fraud scheme, according to a June 13 report from KFF Health News. -
Medicaid disenrollments top 1 million
More than 1 million people have been disenrolled from Medicaid as part of the redeterminations process, according to KFF. -
10 providers seeking payer contracting talent
Ten providers recently posted job listings seeking leaders in payer contracting and relations.
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