UnitedHealthcare CEO Brian Thompson was shot and killed Wednesday morning in New York City, where UnitedHealth Group (NYSE: UNH) was hosting its annual investor conference. New York City Mayor Eric Adams called it a “targeted murder.” The city’s police commissioner, Jessica Tisch, also described it a “brazen targeted attack.” UnitedHealth Group is one of the […]
Category: Medicare Advantage
The Centers for Medicare & Medicaid Services (CMS) is proposing new limits on Medicare Advantage (MA) plans regarding prior authorization, utilization management, coverage decisions and the use of artificial intelligence (AI). These proposed changes aim to address the barriers to accessing care identified by CMS. Data reported to CMS by MA plans show that, on […]
Home health providers may walk away from specific health plans due to financial feasibility, administrative burdens, or misalignment with their patient care values and priorities. However, this decision can create short-term challenges with referral partners and health systems, as they may have patients enrolled in those plans. “If a health plan consistently under-reimburses for services […]
Medicare Advantage (MA) companies have faced an unfavorable rate and regulatory environment over the last couple of years. That has given home health providers hope that MA penetration may cool off. It also has given them a bit more leverage in negotiations. Plans will see a 0.16% decrease to core payments in 2025, a second-straight […]
Essentia Health has reached an agreement with UnitedHealthcare (UHC) to remain an in-network provider for UHC’s Medicare Advantage insurance plan in 2025. Earlier this year, Essentia announced plans to discontinue its status as an in-network provider for UHC and Humana Inc. (NYSE: HUM) Medicare Advantage insurance plans due to reported issues with denials of payment […]
The U.S. Department of Justice (DOJ) and four state attorneys general filed a lawsuit to block UnitedHealth Group’s (NYSE: UNH) acquisition of Amedisys (Nasdaq: AMED) this week. The DOJ’s complaint is thorough, with some compelling arguments, and some less so. Home health veterans have been predicting consolidation of the fragmented industry for a long time. […]
The Cigna Group (NYSE: CI) said on Monday that it is officially not pursuing a combination with Humana Inc. (NYSE: HUM). That means that CenterWell Home Health, one of the largest home health entities in the country, will not be changing hands. Together, Cigna and Humana would have become one of the largest health care […]
Medicare Advantage (MA) star ratings have become a hot topic for Humana Inc. (NYSE: HUM). On Oct. 18, the company filed a lawsuit against the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) over its drop in star ratings. The number of Humana MA plans rated […]
Medicare Advantage (MA) companies receive higher risk-adjusted payments from the Centers for Medicare & Medicaid Services (CMS) for sicker enrollees. This helps ensure that plans receive sufficient payments to cover increased care costs and that enrollees have access to plans. However, a new report states that taxpayers are footing the bill for billions of dollars […]
UnitedHealth Group (NYSE: UNH) and Amedisys (Nasdaq: AMED) leaders are reportedly expected to meet with officials from the Department of Justice over the next week to discuss their pending deal. The companies will likely make a final case for why the deal should go through, while the DOJ considers whether to officially file a lawsuit […]
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