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

Starting 2026, Cleveland Clinic expands healthcare access through AmeriHealth Caritas Florida’s network, enhancing provider options for Marketplace and Medicare Advantage members in South Florida.

Home health providers face challenges shifting from fee-for-service to value-based care due to payer demands and regulatory pressures. Innovative payment models and care delivery adaptations are key to success.

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

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 from $42 following Q2 results, citing ongoing cost trend challenges but strong Prescription Drug Plan and Medicare Advantage performance. Buy rating maintained.

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