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PBM Issues
Progressive lawmakers call on CMS to cull companies with history of Medicare fraud from ACO REACH
At least 10 organizations with records of healthcare fraud and abuse participated in the direct contracting program last year despite CMS...
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Dec 27, 20223 min read
How Medicare Advantage plans dodged auditors and overcharged taxpayers by millions
NPR In April 2016, government auditors asked a Blue Cross Medicare Advantage health plan in Minnesota to turn over medical records of...
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Dec 22, 20225 min read
To Beat Overbilling Allegations, Cigna Says Everybody Does It
Law360 Cigna has told a Tennessee federal judge that the U.S. Department of Justice's False Claims Act lawsuit accusing it of defrauding...
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Dec 20, 20222 min read
Thousands of Tricare Pharmacy Locations Could Be Lost Due to Kroger-Albertsons Merger
Military.com | Patricia Kime A planned merger of Kroger and Albertsons grocery corporations could slash the number of Tricare network...
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Dec 9, 20224 min read
Lawsuit filed against national insulin manufacturers by Kansas Attorney General
KSNT NBC Kansas The Kansas Attorney General filed a lawsuit against leading national insulin manufacturers and pharmacy benefit managers...
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Dec 7, 20222 min read
The health insurer will see you now: How UnitedHealth is keeping more profits, as your doctor
STAT News By Bob Herman Next year, UnitedHealth Group — one of the largest health care companies on the planet — expects to make a lot...
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Dec 5, 20225 min read
World’s Top-Selling Drug Going Off Patent Means Big Bucks for Middlemen
As AbbVie’s Humira faces copycat biologics, the biggest beneficiaries will be the middlemen negotiating and dispensing the drugs such as...
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Nov 30, 20223 min read
Elon Musk, Bernie Sanders and Others Miss the Mark Over Pricey Insulin
Big Pharma has taken much of the heat for sky-high insulin prices, but scrutiny could soon shift to other companies grabbing a growing...
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Nov 29, 20223 min read
What do Ticketmaster and Pharmacy Benefit Managers have in common?
Pacific Research Institute Popular American singer and songwriter, Taylor Swift, released her newest album ‘Midnights’ in October. The...
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Nov 28, 20223 min read
How To Get Away With Corporate Murder: Unbundling And Disrupting Pharmacy Benefit Managers (Part 2)
This two-part article was researched and written in partnership with Cathy DuRei, President of Rumbly Health. Part 1 delved into what a...
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Nov 23, 20228 min read
Hidden audits reveal millions in overcharges by Medicare Advantage plans
NPR Shots: Health News Newly released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage...
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Nov 22, 20225 min read
DOJ to appeal UnitedHealth-Change Healthcare merger challenge
In its antitrust challenge to a UnitedHealth Group-Change Healthcare deal, the Department of Justice argued that the merger would allow...
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Nov 21, 20221 min read
How To Get Away With Corporate Murder: Unbundling And Disrupting Pharmacy Benefit Managers (Part 1)
Forbes If, as Mitt Romney said, a corporation is a person, then is it akin to murder if an idea takes down a company? What about if it...
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Nov 19, 20227 min read
Oklahoma proposes landmark rule to keep mailed medications safe from extreme temperatures
There is little regulation of how pharmacies ship drugs to patients, though extremes of hot or cold can make medicine unsafe or...
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Nov 18, 20223 min read
Express Scripts to pay $3.2 mln to settle Massachusetts overcharge claims
Cigna unit accused of ignoring federal, state drug pricing benchmarks for workers' compensation beneficiaries Massachusetts previously...
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Nov 9, 20221 min read
How the 10 largest PBMs hold huge sway in health care marketplace
American Medical Association What’s the news: The AMA has gathered first-of-its-kind data on pharmacy benefit managers (PBMs) and its...
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Oct 25, 20222 min read
DOJ sues Cigna alleging Medicare Advantage fraud
Modern Healthcare The Justice Department has sued Cigna for allegedly collecting tens of millions of dollars in excess Medicare payments...
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Oct 17, 20222 min read
‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions
By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been...
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Oct 12, 202210 min read
Nearly 20% of Medicare Advantage plans lose star revenue for 2023
Modern Healthcare Just half of Medicare Advantage plans with prescription drug coverage received ratings that will earn them bonuses for...
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Oct 7, 20223 min read
Anthem must face Medicare Advantage fraud lawsuit, judge rules
Modern Healthcare Author: Nona Tepper Anthem must face a Justice Department lawsuit alleging the Medicare Advantage insurer intentionally...
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Oct 5, 20222 min read
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