Celeste Mellet, currently the finance chief at an infrastructure investment fund, will take on the insurer’s CFO role in early January.| Healthcare Dive
The Department of Justice’s (DOJ) health care fraud unit is investigating UnitedHealth Group (NYSE: UNH) for criminal Medicare fraud, according to a| Home Health Care News
As Medicare Advantage (MA) enrollment continues to surge, home health providers have seen slim margins deteriorate further. Some providers have openly| Home Health Care News
UnitedHealth Group (NYSE: UNH) and Humana (NYSE: HUM) are pushing to increase oversight and limit payments to insurers for in-home clinical assessments in| Home Health Care News
As Medicare Advantage (MA) continues its rapid rise, nonprofit home health care companies are grappling with unsustainable reimbursement rates, with some| Home Health Care News
Only 25% of Humana members will be in plans with four stars or above next year, down from 94% this year, the insurer disclosed last week. The downgrade could wipe out Humana’s profits in 2026.| Healthcare Dive
Mehmet Oz, who previously advocated for expanding the privatized Medicare program, said he would tackle upcoding among MA plans if confirmed.| Healthcare Dive
Nearly 50 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees in 2023, of which 3.2 million (6.4%) were denied. Just 11.7% of denied requests were appealed, though 81.7% of appeals overturned the initial denial in Medicare Advantage. Substantially fewer prior authorization requests were made in traditional Medicare, reflecting the small number of services subject to prior authorization requirements.| KFF
Innovative CBO and D-SNP partnerships can help plans engage effectively and authentically with the communities they serve.| Media Logic
A private 2014 decision by the Centers for Medicare & Medicaid Services faces new scrutiny in a multibillion-dollar Justice Department fraud case against UnitedHealth Group.| KFF Health News
How the Burden Reduction Agenda is Evolving| donmoynihan.substack.com