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36 Medicare Advantage plans earning 5 stars from CMS for 2024
Each year CMS publishes Medicare Advantage and Medicare Part D star ratings to measure the quality of health and drug services from Medicare Advantage and Medicare prescription drug plans, or Part D plans. -
States, FTC continue to target noncompetes: 3 updates
Noncompete clauses continue to be the target of lawsuits and action by state legislatures. -
Kentucky system could lose contracts with Humana, Wellcare and UnitedHealthcare
Baptist Health Medical Group, part of Louisville, Ky.-based Baptist Health, terminated its contract with Humana Medicare Advantage last month. Now, the system's Medicare Advantage contracts with UnitedHealthcare and Wellcare are on the line, according to an Oct. 19 report from Louisville Public Media. -
ECU Health, WakeMed to drop Humana Medicare Advantage plan members
Humana Advantage Plan members in North Carolina will no longer be in network with Raleigh-based WakeMed and Greenville-based ECU Health, according to an Oct. 19 report from CBS affiliate WNCT. -
The 10 largest payers in the US by market share
UnitedHealthcare Group, which has an annual revenue of $324 billion, is the largest health insurance company in the U.S. by market share, according to a report from ValuePenguin updated in October. -
Ohio system cuts ties with Anthem, Humana Medicare Advantage plans
Zanesville, Ohio-based Genesis HealthCare System will no longer accept Anthem or Humana Medicare Advantage plans beginning in 2024. -
Ascension Saint Thomas ASC now part of Farm Bureau Medicare Advantage network
Columbia, Tenn.-based payer Farm Bureau Health Plans has added Nashville, Tenn.-based Ascension Saint Thomas to its Medicare Advantage provider network. -
What to know about Stark law's $9.2M record in self-disclosures
CMS settled a record-breaking $9.29 million in Stark law voluntary self-referral disclosure settlements in 2022, according to recent CMS data. -
WVU Medicine adds in-house Medicare Advantage plan
Morgantown-based West Virginia University Medicine has launched an in-house health insurance services company, Peak Health, which has been serving WVU Medicine employees. Now, the system is expanding its offerings to Medicare-eligible patients throughout the state, according to an Oct. 19 report from The Weirton Daily Times. -
ASC's physician bonus structure avoids kickback issues, OIG says
HHS' Office of the Inspector General has confirmed broad protection of employee safe harbor under anti-kickback laws in a recent ruling involving physician ownership of an ASC, according to an Oct. 17 article in JDSupra written by law firm Sheppard Mullin. -
Physicians urge CMS to stop policy that could drastically reduce reimbursements
CMS is floating the implementation of a separate add-on payment for healthcare common procedure coding system code G2211 in its 2023 Medicare Physician Fee Schedule, according to an Oct. 13 report in JDSupra written by law firm Reed Smith. -
Here is what 3 major payers have been up to this month
From negotiating new contracts to expanding plans, here are five moves from these three major payers since Oct. 2: -
Cigna to pay $172M over alleged Medicare Advantage overpayments
Health insurer Cigna has been ordered to pay over $172 million to settle claims that it submitted false diagnosis codes to Medicare Advantage, according to an Oct. 2 report from CBS News. -
Cigna expands Medicare Advantage plan to Nevada
Cigna healthcare is expanding its Medicare Advantage plans to patients in Nevada for the first time, launching in two counties in the Las Vegas area. -
Aetna Medicare Advantage audit discovers $25.5M in overpayments in 1 year
This year, the U.S. Office of the Inspector General conducted an audit of insurer Aetna's Medicare Advantage program to ensure that selected diagnosis codes Aetna submitted to CMS for use in CMS' risk adjustment program complied with federal requirements. -
Virginia health system ends Medicare Advantage plans
Fredericksburg, Va.-based Mary Washington Healthcare will no longer offer Medicare Advantage plans beginning next year, citing rising costs, operational challenges and the impact of COVID-19, according to an Oct. 11 report from The Free Lance-Star. -
The Hidden Perils of Silent PPOs: A Challenge for Healthcare Providers
While PPOs are generally considered beneficial for providers due to the promise of a broader patient base, silent PPOs bring forth an array of hidden pitfalls and challenges they pose for healthcare providers. -
Another health system could go out of network with UnitedHealthcare
Louisville, Ky.-based Baptist Health could be going out of network with UnitedHealthcare for certain Medicare enrollees after its contract with the payer expires on Jan. 1, according to an Oct. 6 report from WDRB. -
University Hospitals launches in-house Medicare Advantage plan
Cleveland, Ohio-based University Hospitals has launched a co-branded Medicare Advantage Plan for individuals in three Ohio counties in partnership with PrimeTime Health Plan. -
UnitedHealthcare in the headlines: 5 notes
UnitedHealthcare is one of the country's largest payers.
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