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Payers have faced state penalties in 2024 for slow reimbursements, improper claims denials, or the sale of unapproved products. 12 recent examples of payers fined or agreeing to settlements with ...

Humana and CommonSpirit hospitals in Colorado will go out-of-network Jan. 1, 2025. The contract split applies to Humana Medicare Advantage plans, according to a statement CommonSpirit shared with ...

Aetna is laying off 164 remote employees "due to an unexpected loss of contract in Kansas." The layoffs will take place in February 2025, according to regulatory documents filed with Connecticut ...

HHS' Office of Inspector General has issued a special fraud alert about the risks of fraud and abuse in certain marketing and compensation arrangements related to Medicare Advantage. The December ...

The prices for some GLP-1s have dropped significantly in recent years for individuals covered by Medicare and commercial insurance, according to a new report from HHS. In 2024, the U.S. list prices ...

Georgia will award Medicaid contracts to four Medicaid managed care organizations. According to a notice published Dec. 2, the agency plans to grant Medicaid contracts to Humana, CareSource, Molina ...

Sanford Health Plan is expanding its Medicare Advantage offerings to more rural communities. In December, Sanford Health Plan, part of Sioux Falls, S.D.-based Sanford Health, partnered with Lincoln, ...

UnitedHealth Group is the largest insurer in the United States by membership and the largest employer of physicians in the country. The company was founded by physicians and other healthcare ...

An Illinois lawmaker has introduced legislation that aims to provide greater oversight of how insurers use artificial intelligence in decision-making processes. If enacted, the state would have the ...

Payers are trimming their workforces and cutting jobs due to financial or operational challenges, along with restructuring strategies. Below are workforce reduction efforts or job eliminations that ...