Evidence

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 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

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

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

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

Vision can be an overlooked element of health. But not for Aetna, who launched a new policy requiring prior authorization for all cataract surgeries as of July 1. Per a recent article… Read More

It’s common knowledge at this point – insurers made a killing last year due to the pandemic. Limited care led to fewer medical claims, which led to more dollars in insurers’ pockets.… Read More