Payer: Page 2
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CMS expands audits to crack down on Medicare Advantage overpayments
The agency said it would increase the number of MA plan audits and complete its backlog of reviews by investing in technology and growing its medical coding workforce.
By Emily Olsen • May 22, 2025 -
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House passes reconciliation bill with massive Medicaid cuts
Speaker Mike Johnson negotiated a number of last-minute changes to the megabill to ensure passage, including moving up the start date for Medicaid work requirements. The House passed the bill 215-214 on Thursday morning.
By Rebecca Pifer • May 22, 2025 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
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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Judge denies Florida Blue’s request to bump star ratings
The insurer sued the CMS late last year, arguing that flooding in Broward County should have qualified as an extreme and uncontrollable event relieving Florida Blue from star ratings decreases. A federal judge disagreed.
By Rebecca Pifer • May 21, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth downgraded by investment banks
TD Cowen, Raymond James and Bank of America have all downgraded UnitedHealth’s stock, citing dogged internal challenges facing the company.
By Rebecca Pifer • May 20, 2025 -
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Judge shuts down drugmakers’ 340B rebate plans, for now
A district court ruled that the HHS does have the power to review drug manufacturers’ plans to pay hospitals rebates instead of upfront discounts on 340B medications. But it left the door open to the controversial reforms.
By Rebecca Pifer • May 19, 2025 -
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Sponsored by VeradigmHow payers can drive value-based care forward
Lead value-based care with data, tech and the Veradigm Network advantage.
By Veradigm • May 19, 2025 -
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RFK Jr. calls GOP Medicaid plans ‘not true cuts’
Republicans’ plan to reduce spending on Medicaid would eliminate waste, fraud and abuse, the HHS secretary said in hearings last week. Millions could become uninsured under the proposal.
By Emily Olsen • May 15, 2025 -
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Deep DiveHouse committees advance reconciliation text with big impacts on healthcare
Republicans in Energy and Commerce and Ways and Means have approved their portions of President Donald Trump’s “big, beautiful bill” after marathon markups. Here’s an extensive look at what the legislation means for healthcare.
By Rebecca Pifer • May 15, 2025 -
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Stopping a ‘moral obscenity’: Senate Judiciary Committee expresses support for PBM reform
Sen. Chuck Grassley, R-Iowa, suggested Congress could once again move to overhaul PBMs’ controversial business practices after legislators pass President Donald Trump’s conservative megabill this summer.
By Rebecca Pifer • May 14, 2025 -
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CMMI revamps strategy to focus on disease prevention, cost savings
“Our system is facing unsustainable cost pressures,” said Director Abe Sutton. “We are pouring resources into treating disease after onset, rather than tackling the root causes and preventing it.”
By Emily Olsen • May 13, 2025 -
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Andrew Witty steps down as UnitedHealth CEO
Witty’s departure was surprising, though it follows a sharp downturn in the healthcare juggernaut’s financial outlook. He is being replaced by Stephen Hemsley, the chair of UnitedHealth’s board and a previous chief executive.
By Rebecca Pifer • May 13, 2025 -
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House Republicans unveil Medicaid cuts including work requirement, provider tax freeze
The House Energy and Commerce Committee is backing more moderate reforms to Medicaid. But Republicans’ policy proposals would still result in millions of Americans losing health insurance.
By Rebecca Pifer • May 12, 2025 -
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Millions could lose coverage under potential GOP Medicaid policies: CBO
The Congressional Budget Office expects states will replace about half of the reduced federal support with their own resources, and then reduce spending by cutting provider payment rates, optional benefits and enrollment.
By Emily Olsen • May 9, 2025 -
Emily Olsen/Healthcare Dive
Deep DiveMedicaid cuts could have ‘drastic impact’ on providers
Some providers may need to reduce services, lay off staff or close their doors if Congress enacts major cuts to the safety-net insurance program, experts say.
By Emily Olsen • May 9, 2025 -
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Democrats urge Republicans to focus on Medicare Advantage upcoding instead of Medicaid cuts
Stopping MA insurers from inflating their reimbursement is a better strategy to save federal dollars than restricting benefits or cutting eligibility in Medicaid, the Democrat lawmakers wrote to GOP leadership.
By Rebecca Pifer • May 9, 2025 -
Courtesy of UnitedHealth Group
Shareholders sue UnitedHealth for obfuscating business impacts from Thompson death
The lawsuit, which seeks class action status, alleges that UnitedHealth and its executives didn’t properly warn investors about how the killing of UnitedHealthcare CEO Brian Thompson would affect its business.
By Rebecca Pifer • May 8, 2025 -
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Health insurers see signs of life in Q1
Payer profits fell in 2024 as Americans, especially older ones, utilized more medical care. But efforts to resuscitate margins appear to be working for most — at least for now, according to first quarter results.
By Rebecca Pifer • May 7, 2025 -
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UnitedHealth, Amedisys reach new deal to sell home health and hospice locations if merger approved
The sales are contingent on the closure of UnitedHealth’s acquisition of Amedisys, which has been held up after the Department of Justice sued to block the deal last year.
By Emily Olsen • May 6, 2025 -
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Trump releases 2026 budget including heavy healthcare cuts
White House officials say the budget, which would slash the HHS’ discretionary funding by 26%, is necessary to curb government bloat. Medical groups say it amounts to an attack on biomedical funding and public health.
By Rebecca Pifer • May 5, 2025 -
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Sponsored by Quest DiagnosticsMind the gap: How lab partners can help Part C plans adapt to Medicare Star Rating changes
A 1-star boost in Medicare ratings can add up to $16.2M in revenue and 8–12% enrollment growth.
May 5, 2025 -
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Cigna doubles down on GLP-1 support programs with 2 new launches
On Friday, the company’s health services unit Evernorth unveiled new programs in a reliable growth area: helping payers manage GLP-1 utilization. Cigna also posted first quarter results well above analyst forecasts.
By Rebecca Pifer • May 2, 2025 -
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DOJ accuses CVS, Humana, Elevance of paying kickbacks to Medicare Advantage brokers
According to the complaint, the insurers paid brokers eHealth, GoHealth and SelectQuote hundreds of millions of dollars for enrolling seniors in their MA coverage — regardless of the plans’ suitability for those members’ needs.
By Rebecca Pifer • Updated May 2, 2025 -
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CVS plans to exit ACA individual exchanges, strikes Wegovy deal with Novo Nordisk
Aetna is once again retreating from the Affordable Care Act market, while its parent company notched a deal with Danish drugmaker Novo Nordisk that should expand access to its in-demand GLP-1 at the expense of Eli Lilly’s.
By Rebecca Pifer • May 1, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth names new CEO of Optum
Patrick Conway will replace Heather Cianfrocco, who is being promoted to UnitedHealth’s executive vice president of governance, compliance and information security, the company announced Tuesday.
By Rebecca Pifer • April 30, 2025 -
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Republican lawmakers urge CMMI to focus on cost savings, transparency
Lawmakers on the House Ways and Means Committee also accused CMMI of promoting “a political agenda,” like focusing on health equity and minimizing the importance of cost savings.
By Emily Olsen • April 30, 2025
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