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Centene and the Managed Care Mischief

Our friends Centene Corporation are back with the next installment of our favorite series: Managed Care Mischief. According to an article in Healthcare Dive, Centene’s settled another set of allegations that it… Read More

You get a bill, you pay it. Right? Not these two top health insurers…

A pair of insurers have yet to pay their bills, and we aren’t talking chump change. Provider representatives say the insurers are billions of dollars behind on payments owed to hospitals and… Read More

Breaking news for the DHHS…but not for us

Finally, at (very) long last, the Department of Health and Human Services (DHHS) is putting the many pieces of Medicare fraud together. An exclusive report in the Wall Street Journal explains that… Read More

Spotted: More growth for Humana?

Word on the street (StreetInsider, to be specific) is that Humana has its eye on a shiny new purchase: Medicaid managed-care organization (MCO), Centene. A recent Fierce Healthcare article gives us the… Read More

Blue Cross Blue Shield, will you ever learn?

Remember back in May, when Blue Cross Blue Shield (BCBS) settled for a cool $2.67 billion in a highly publicized antitrust case? We sure do. Here’s a refresher: The BCBS Association was… Read More

More ghost networks, just in time for Halloween

Another ghost network story is giving us chills. A new whistleblower case reported in Modern Healthcare, alleges Aetna illegally secured contracts with Pennsylvania’s Medicaid program, HealthChoices, by misrepresenting the number of pediatricians… Read More

A private health plan mismanaging government funds? Color us shocked.

The Centers for Medicare & Medicaid Services (CMS) suspended enrollment in not one, but three Medicare Advantage plans offered by UnitedHealthcare. What happened? Well, the Social Security Act requires that health insurance plans have… Read More

Is this mic on? We’ve been looking for some clarity on record-breaking profits for insurers

We interrupt our regular programming to take you back to Connecticut, where insurance scrutiny remains high. Which, if we’re being honest, is our regular programming. Just last week, we covered the Connecticut… Read More

Is United penny-pinching pediatricians?!

UnitedHealthcare is known for denying coverage. Old story, we know. But now, they’ve targeted pediatricians. Seems a little aggressive, right? The American Academy of Pediatrics (AAP) seems to agree, and they aren’t… Read More

Here’s what we know about the latest reconciliation bill drama

Change is a-coming, as it normally does during a new legislative year. This year, Congress is mid-debate on Biden’s bipartisan infrastructure bill and Democrats’ $3.5 trillion reconciliation bill, which includes Medicare reform.… Read More

Surprise! But not the good kind

You got your COVID-19 vaccine. You get your COVID-19 tests as necessary. Due diligence has been served, right? Well, don’t look behind you—here come the COVID-19 testing bills (and collection agencies). Per… Read More

Anthem forced to foot the bill for eating disorder coverage

Eating disorders are common—the mental health disorders affect nearly 30 million Americans. This is no small number, nor is the price tag associated with its care. An article in Becker’s Hospital Review… Read More

We have a hospital bed pile-up… that could easily be prevented

In a time when the Delta variant is raging and post-acute patient care is needed most, this is not the time for setbacks or bureaucracy. Leave it to insurers, though: Medicare Advantage… Read More

(Some) states push back on rate increases—finally!

It’s that time of year. No, not just for pumpkin spice lattes, but for health insurers to petition state Departments of Insurance for the next year’s rate increases. Everybody, brace yourselves. Each… Read More

D.C. Circuit overruling means the game is afoot!

A new court case has us predicting more False Claims Act suits against private payors operating Medicare Advantage plans. Let’s hope so, but first, let’s break it down. First: Medicare Advantage. Private… Read More

Who is responsible for preparing states for healthcare “storms”?

Storm preparation is a major priority for many cities across the nation, and rightly so. But where’s the preparation for healthcare “storms,” like COVID-19? Mississippi has what’s believed to be the weakest… Read More

Our take on Michigan insurers: “Another COVID-19 surge? Sounds like a ‘you’ problem…”

We sure hope you’re vaccinated, Michiganders! (And hope you don’t catch a breakthrough infection, despite your best efforts.) Your state’s two largest carriers are sunsetting COVID-19 cost waivers. You heard that right.… Read More

The prior authorization saga in Illinois could be making some headway

Introducing our newest hero: Illinois Governor JB Pritzker, who is throwing out new legislation for the betterment of healthcare in Illinois. The motive: calling into question the concept or execution of prior… Read More

Insurers keep going into overtime…and overtime…and overtime

When a football game goes into overtime, it’s exciting, competitive, and generally applauded. But when enforcement of health insurer transparency goes into overtime, it’s frustrating, exhausting, and costly. Per a recent Fierce… Read More

How much is your life worth? Apparently about $450

We’ve covered it before: UnitedHealthcare’s business practices often make mental healthcare harder to access—and it seems like New York State agrees. We’re happy to report, per a recent Reuters article, that the… Read More

Centene is not admitting fault for recent lawsuits…but still paying the price.

Centene might not be one of the Big Five health insurers, but it sure knows how to “follow the leader” when it comes to sneaky business. Oh, and did we forget to… Read More

The DOJ is AHA’s newest pen pal. Their mutual concern? United.

You can always count on the American Hospital Association (AHA) to address red flags from insurers, namely, UnitedHealthcare. Thumbs. Up. AHA’s latest effort involves a letter addressed to the Department of Justice… Read More

Two trips to space, or roughly $11B. That’s how much insurers profited in Q2 this year

Drum roll, please. It’s earning season once again and, sure enough, five of America’s largest health insurers cleaned up in Q2. We’re not just talking “cleaned up”—we’re talking bleached, waxed, and wiped… Read More

All aboard the insurer investment train to end-stage renal disease

We’re hearing a bit more than crickets from Cigna. According to a Modern Healthcare article, Cigna and Blue Shield of California participated in a $83.5M funding round for Cricket Health, a software… Read More

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