Federal prosecutors and auditors are targeting Medicaid behavioral health fraud on multiple fronts, with billions in alleged false claims under scrutiny nationally and two states alone facing audit ...

Kansas Attorney General Kris Kobach filed a lawsuit in state court June 24 against Aetna, alleging the insurer misused tens of millions of dollars while administering the state employee health plan.

Thirty-one House Democrats are seeking more information on CMS’ Wasteful and Inappropriate Service Reduction model. The lawmakers sent a letter to CMS Administrator Mehmet Oz, MD, June 22, requesting ...

Earlier in June, the HHS Office of Inspector General published two reports shedding light on post-acute care denials and overturned appeals from Medicare Advantage organizations. AHIP is pushing back.

Sustainability has become less about cutting costs and more about redesigning how healthcare delivers value. Becker’s asked several health plan leaders how they’re thinking about long-term ...

Centene is offering a voluntary separation program to employees, the company confirmed to Becker’s June 15. “Centene is positioning the company to lead the future of healthcare — working to deliver a ...

CMS on June 1 published the interim final rule outlining how states will carry out Medicaid work requirements. The rule sets the operational framework for a policy hospitals warn will push eligible ...

Prior authorization reforms in Massachusetts went into effect June 5. Democratic Gov. Maura Healey finalized the regulations in May, following through on her earlier plan to tackle prior authorization ...

Albuquerque, N.M.-based Presbyterian Healthcare Services will end most of its Medicare Advantage plans in 2027 and lay off about 150 health plan and administrative employees, a spokesperson for the ...

Blue Shield of California is laying off 69 employees, effective July 28. The insurer filed Worker Adjustment and Retraining Notification Act notices May 29. The layoffs span Alameda, El Dorado, Los ...

The House Appropriations Committee moved forward with an amendment that would block funding for a CMS pilot that brings prior authorization requirements to traditional Medicare. The lawmakers adopted ...

CareFirst BlueCross BlueShield has secured a two-week pause in its 2026 Medicare Advantage star ratings lawsuit, pointing to a ruling against the government last month that found widespread flaws in ...