A class action lawsuit accuses Blue Shield of California and Magellan Health of maintaining a ghost network of mental health providers, impacting patient access and regulatory compliance.

GAO report reveals systemic fraud in ACA marketplace subsidies, causing billions in improper payments and driving up healthcare costs. Policy reforms seek to improve program integrity and reduce premiums.

Congress confronts a critical deadline to extend Affordable Care Act subsidies amid partisan divisions, impacting health insurance markets and regulatory compliance.

Indian national sentenced to two years for Medicare fraud involving fake COVID-19 testing claims totaling over $1.17 million. The case highlights ongoing challenges in health care fraud detection and regulatory compliance.

Patrick C. Moore Jr. sentenced to 46 months and $7.2M restitution for Medicare genetic testing kickback fraud. DOJ and HHS-OIG enforcement highlights healthcare fraud risks.

State Farm is involved in ongoing lawsuits alleging a multi-billion dollar scheme in Oklahoma homeowners insurance claims, raising regulatory and compliance issues.

Pharmaceutical companies agree to significant Medicare drug price cuts under Trump administration, projecting billions in savings with impacts on Medicare Part D and drug affordability.

CMS proposes to revamp Medicare Advantage Star Ratings, affecting insurer compliance and operations. Legal appeals and health system updates also impact the US market.

Explore key trends affecting U.S. healthcare insurance including capacity changes, pricing dynamics, claims severity, and regulatory challenges across home healthcare, allied health, senior care, and life sciences sectors.

Medicare delays $7.8B hospital drug cost clawback, appeals MA audit ruling, and adds cardiac ablations to ambulatory surgery coverage for 2026.