INSURASALES

Tag: Managed Care

Freedom Health Settles Medicare Advantage False Claims for $31.7M

Freedom Health agreed to pay $31.7M to settle allegations of False Claims Act violations relating to Medicare Advantage payment schemes. The settlement underscores regulatory enforcement in managed care and Medicare compliance.

DOJ Sues California Medicaid Plan Over $320M Misused Federal Funds

The DOJ sues Inland Empire Health Plan for allegedly misusing $320 million in federal Medicaid surplus funds, highlighting compliance challenges in managed care programs.

Kansas Medicaid KanCare Expands Maternal Care Services and Provider Network

Kansas Medicaid's KanCare expands maternal care services, adding providers and extending postpartum coverage to support pregnant and postpartum beneficiaries through enhanced MCO contracts and reimbursement policies.

CareOregon Ends Out-of-Network Behavioral Health Coverage in Oregon

CareOregon will discontinue out-of-network behavioral health coverage for Medicaid and Medicare Advantage members, impacting 15,000 patients in Oregon. The change aligns with industry practices post-COVID-19 expansion.

Crowell & Moring Expands Healthcare Litigation Team, Boosts Nationwide Reach

Crowell & Moring expands its healthcare litigation practice with 16 partners from Reed Smith, enhancing nationwide legal services across managed care and healthcare law.

Virginia Bureau of Insurance Defines Material Change Rules for Managed Care Plans

Virginia's Bureau of Insurance clarifies material change filing requirements for managed care plans, emphasizing 5% financial impact threshold and compliance penalties to guide health carriers.

Truist Lowers Centene Price Target to $35, Maintains Buy Rating After Q2 Results

Truist lowers Centene price target to $35 from $42 following Q2 results, citing ongoing cost trend challenges but strong Prescription Drug Plan and Medicare Advantage performance. Buy rating maintained.

UnitedHealth Faces Investor Scrutiny Amid Rising Costs and Regulatory Challenges

UnitedHealth's CEO Stephen Hemsley addresses investor concerns amid rising medical costs, regulatory investigations, and operational challenges affecting the insurer's 2025 earnings forecast and market confidence.

Medicaid Cuts and Work Requirements Threaten Coverage for Millions Nationwide

Medicaid funding cuts and new work verification rules under 2023 tax legislation risk coverage loss for millions, complicate state programs, and shift costs to states.

Cigna Outperforms UnitedHealth Amid Managed Care Sector Challenges

Analyze how Cigna outperforms UnitedHealth in the U.S. managed care sector amid rising medical costs and regulatory challenges. Insights on earnings, valuation, and sector strategy.