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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

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

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

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

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

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

United members expect coverage for post-cancer surgery. United says: “Nah.”

So, let’s say a woman you know is diagnosed with breast cancer, and with the right healthcare, she beats it. It’s a tough fight, but she beats it. Everybody breathes a sigh… Read More

Aetna: keeping it class(action)y

Do you ever wonder whether some insurers may simply have chosen the wrong line of work? The basic exchange in health insurance entails receiving money from people who want their healthcare needs… Read More

A surprise bill from United (that we could have seen coming)

Insurers like to lay the blame for surprise medical bills on providers. Sometimes, they’re even brazen enough to blame their own members, claiming that they have failed to scrutinize their insurance coverage… Read More

Oops, Humana did it again

Is it just us, or do health insurers seem to be, um, taking advantage of Medicare Advantage (MA)? This year alone, we’ve seen stories about Cigna and Anthem hitting stop signs on their… Read More

The battle of the blacklisted anesthesiologists

The New York Times recently devoted more than 1,000 words to the legal dispute between UnitedHealthcare and the private-equity-backed, physician-owned practice U.S. Anesthesia Partners (USAP). It’s an illuminating read—here are the highlights.… Read More

Humana’s operations expand—and so does its rap sheet

In the past few weeks, we’ve seen a glimpse of what Humana might look like as it grows in size and becomes a bigger employer. And, to be honest, we’re a little… Read More

Mississippi to Centene: I want my millions back too!

When the Mississippi Department of Medicaid contracted with Centene Corp. subsidiary Magnolia Health to manage care for the nearly half a million lower-income adults and children in its Medicaid system (MississippiCAN), state… Read More

United’s pending purchase of Change Healthcare goes under the DOJ’s microscope

You may have read our earlier coverage of UnitedHealthcare subsidiary Optum’s intended purchase of Change Healthcare, the enormous administrative network that processes claims and medication requests for physicians and pharmacies. Recently, the… Read More

Antitrustworthy: Michigan Blues customers see red

There seem to be a lot of antitrust issues with health insurers at the moment. Today’s tale involves a suit against Michigan Blues (the umbrella name for Blue Cross/Blue Shield and Blue… Read More

Ohio to Centene: I want my millions back!

Well, here we are again. Yet another group is calling in counsel—and calling out insurers—on their shady practices related to pharmacy benefit managers (PBMs). This time, it’s Ohio’s attorney general Dave Yost,… Read More

United vs. patients: The never-ending story

We feel for the UnitedHealthcare legal team. They must be worn out these days, what with so many lawsuits taking them to task for alleged misdeeds like fraud and illegally refusing to cover… Read More

Misled consumers fight back against “junk” health plans

“What you see is what you get” wasn’t the case for more than 200,000 consumers who thought they were scoring good deals on decent health insurance plans. Burned by a deceptive marketing… Read More

Legislators push to prevent a sudden loss of telehealth services after COVID-19

One of the few upsides of the COVID-19 pandemic has been the rapid rise of telehealth. In the past, federal legislation has limited Medicare coverage for telehealth, but thanks to policy changes… Read More

Did Cigna take advantage of a surge in COVID-19 hospitalizations to deny claims?

New York resident Dinah Nissen was bitten on her right cheek by a dog in mid-May. After a clinician at a local urgent care urged her to see a plastic surgeon immediately,… Read More

Update on United’s acquisition of Change Healthcare: Shareholders and providers expressing concern

In early January, we shared our point of view on UnitedHealthcare’s planned acquisition of the data company, Change Healthcare. To no one’s surprise (at least not ours), there is some controversy surrounding… Read More

CMS is pushing payors to improve prior authorizations processes

It looks like prior authorizations—or more specifically, the myriad challenges providers face around prior authorizations—are becoming an Un-covered theme. If you’ve been following our feed, you’ll recall that we recently shared our… Read More

Insurers in Massachusetts sued for hawking misleading plans

We recently covered how UnitedHealthcare’s short-term health plan Golden Rule was able to shirk responsibility for covering a man’s cancer treatment. Now, Massachusetts Attorney General Maura Healey is suing three health insurance… Read More

Cigna sued for refusing to cover COVID-19 testing

Life as we knew it completely changed in March, when the country began navigating the new normal of living in a pandemic. The novel coronavirus completely dominated the spring news cycle, and… Read More

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