A new federal rule will encourage states to ramp up auditing of Medicaid managed-care insurers, many of which keep their medical spending hidden from public view.
It's a tough feat keeping track of people unnecessarily racking up mileage in the ER or making sure they take their medications on time. But if Rush Health in Chicago can hit certain quality measures and cut medical costs while doing so, they can essentially get a financial bonus from Cigna.
Anthem's legal strike against Express Scripts Holding Co. may spur other health insurance companies to re-evaluate their contracts with pharmacy benefits managers to see if they are getting shortchanged on drug savings.
The CMS has awarded Texas a 15-month extension waiver that would help cover the unpaid bills of Medicaid-eligible and uninsured patients in the state. The extension prolongs a standoff between Texas and the White House, which was hoping to instead see the state expand Medicaid.
Two House committees are charging HHS illegally paid states to provide health coverage to people earning between 138% and 200% of poverty without congressional appropriation. States were given the option of providing Basic Health Program coverage in the ACA.
UnitedHealth Group may be abandoning most of the Affordable Care Act's insurance exchanges due to steep losses. But Centene Corp. is doing just fine.