A federal jury in the Southern District of Florida convicted the founder and owner of HealthSplash for his role in a scheme that prosecutors said fraudulently billed Medicare and other federal ...

Two manufacturers filed a lawsuit against Blue Cross and Blue Shield of Texas over alleged prescription drug rebate fraud, according to an April complaint. Texas State Rep. James Frank, a Republican, ...

Optum Rx, UnitedHealth Group’s pharmacy benefit manager, said it will roll out a fee-based structure to customers in the coming years. A May 11 news release from Optum said Optum Rx’s agreements have ...

Iowa Republican Gov. Kim Reynolds signed a law May 13 that enacts prior authorization reforms and prohibits insurers from penalizing providers for out-of-network referrals, according to the Iowa ...

Payers nationwide are striving to operate more efficiently, while maintaining high levels of member and provider satisfaction. Success stems from reducing the friction and costs associated with core ...

Telehealth programs don’t stall because of a lack of vision; they stall when policy requirements outpace implementation. This session is designed to close that gap. Healthcare leaders from health ...

Payers have faced state penalties in 2026 for slow reimbursements, mishandled member complaints, and mental health parity violations. Fines in 2025 are here. Five insurers — Aetna, Cigna, Molina’s ...

AHIP's chief executive criticized the hospital lobby's response to the Change Healthcare cyberattack as "opportunistic" and "maintaining the status quo." Blue Shield of California is working with big ...

A departing senior Elevance Health executive is pushing back against demands from the Justice Department to depose him in a Medicare Advantage fraud lawsuit against ...

Portland, Ore.-based Legacy Health is back in network with Regence — a Blues carrier under Cambia Health Solutions — according to updates from both organizations. The agreement is retroactive to April ...

Marketplace enrollment soared at over 24 million plan selections for 2025, but the enhanced premium tax credits that enabled this surge are set to expire at the end of the year. Some 4.8 million ...