Founded in 2023, Texicare — a Texas Mutual affiliate — offers health coverage to small businesses throughout the state. Texicare President and CEO Meredith Duncan previously worked at Aetna, Bright ...
CMS estimated there were $28.83 billion in improper payments for Medicare fee for service in fiscal 2025. “While CMS’ improper payment reporting programs are designed to protect the integrity of CMS ...
Going into 2026, prior authorization continues to be a contentious topic for payers, providers, lawmakers and other leaders. From piloting prior authorization in Medicare to governors pitching reforms ...
Insurance commissioners significantly shape the industry’s regulatory landscape in each state. A handful even come from healthcare backgrounds, specifically. Becker’s compiled a list of these leaders ...
CMS is moving to replace four legacy Medicare claims platforms. Now, it is seeking a vendor to design one platform that would assume all four systems’ responsibilities. In a Jan. 8 request for ...
Four hospitals under Grand Rapids and Southfield, Mich.-based Corewell Health are no longer in UnitedHealthcare’s network, according to a Dec. 31 update from the insurer. As of Jan. 1, ...
Clover Health reported 53% year-over-year growth in Medicare Advantage PPO membership, according to a Jan. 14 news release from the insurer. The growth translated to roughly 153,000 members, building ...
Oakland, Calif.-based Kaiser Permanente has agreed to pay $556 million to resolve allegations that it violated the False Claims Act by submitting invalid diagnosis codes for Medicare Advantage ...
ACA marketplace enrollment is declining nationally and Congress is struggling to extend the expired subsidies. 2. ACA marketplace enrollment dropped to 22.8 million for 2026, down 3.4% from the same ...
Georgia has issued nearly $25 million in fines to 11 health insurers for violating state mental health parity laws. The penalties follow market conduct examinations that began after a 2023 data call ...
Aetna’s Medicaid President, Mark Santos, has been named senior vice president and head of network strategy and provider experience. Mr. Santos has been with the insurer for more than two decades, ...
L.A. Care Health Plan is laying off 225 employees by March 13. The insurer told Becker’s the move affects 3% of its workforce and was driven by federal and state Medi-Cal budget reductions, which ...
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