CMS has proposed two new models aimed at curbing Medicare drug spending by linking payments to international benchmarks. The proposals — GUARD for Part D drugs and GLOBE for Part B — are the latest in ...

UnitedHealth Group has released findings from multiple independent reviews of its business practices following a June pledge from CEO Stephen Hemsley to conduct a transparent and comprehensive ...

CMS is terminating its Medicare Advantage contract with American Health Plan of Texas after the insurer failed to meet minimum quality standards for three consecutive years. The agency issued a notice ...

UnitedHealthcare is delaying a coverage policy that would have sharply restricted remote physiologic monitoring services for most chronic conditions. The policy, which had been scheduled to take ...

The American Hospital Association and Federation of American Hospitals are calling on Elevance Health to rescind a new policy that would penalize hospitals for using out-of-network providers. In a Dec ...

CMS will launch a voluntary pilot in 2026 to gather service-level data on prior authorization determinations and appeals in Medicare Advantage, according to a Dec. 16 memo. After the pilot, the agency ...

CMS is launching its long-term enhanced accountable care organization design, or LEAD, model at the end of 2026, following the conclusion of the ACO realizing equity, access and community health model ...

A group of 33 NorthStar anesthesia providers filed a lawsuit against Aetna and Cigna over an alleged $4.1 million in No Surprises Act underpayments, according to Dec. 8 filings in Connecticut’s U.S.

Humana’s Louisiana business received at least $10.5 million in Medicare Advantage overpayments in 2017 and 2018, according to an audit report from HHS’ Office of Inspector General. The audit, ...

California’s Department of Managed Health Care fined three Centene-owned health plans a total of $1.7 million over concerns about not meeting reporting rate standards for timely access of appointments ...

Humana’s insurance segment president, George Renaudin, will retire by the third quarter of 2026 following a nearly 30 year career at the company. He will serve as a strategic advisor to the company ...

Kaiser Permanente’s Northern and Southern California health plans have been named the highest-quality commercial plans in the state by the California Center for Data Insights and Innovation. The ...