UNH (US)


August 18, 2025

[CVS, CI, UNH, ELV]: CA’s PBM Reform Bill Appears Next Up in PBM Fight

By Beth Steindecker

With California’s legislature coming back Monday from its summer recess for its final few weeks of the regular session, pharmacy benefit manager (PBM) legislation is still on the docket and likely to invite headline risk…

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August 13, 2025

[PNTG, EHAB, BTSG, ADUS, AMED, AVAH, UNH]: Where Might CMS Go with Home Health Rates?

By Beth Steindecker

With slightly more than two weeks left in CMS’s comment period for the CY26 Medicare reimbursement proposal rule for home health [PNTG, EHAB, BTSG, ADUS, AVAH, AMED, UNH], we continue to expect mitigation from CMS’s…

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July 28, 2025

CY26 Medicare Part D: Additional Spending but CMS Starting to Put on the Brakes

By Beth Steindecker

Today’s CMS release regarding its CY26 Medicare Part D program gives  the impression the agency is focusing on stability in its drug benefit program with the goal to ensure 1) enrollees – especially those in…

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July 16, 2025

Medicare CY26 OPPS Proposal: Hospital Outpatient Departments a Loser While ASCs a Winner

By Beth Steindecker

Hospitals [CYH, ARDT, UHS, THC, HCA] were on the losing end of the stick under CMS’s proposed CY26 Medicare reimbursement rule for hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs) for a variety of…

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July 2, 2025

Medicare Advantage RADV Update: Tons More PY19 Audits, UNH Has the Most For Now

By Beth Steindecker

CMS’s addition last week of 300+ Medicare Advantage (MA) [UNH, HUM, CNC, ELV, CVS, ALHC] contracts to be audited for risk adjustment data verification (RADV) during plan year (PY) 2019 raises the risk of larger…

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June 23, 2025

Home Health: Potential Substance of Upcoming CY26 Medicare Rate Proposal [AMED, PNTG, BTSG, ADUS, AVAH]

By Beth Steindecker

In the upcoming CY26 Medicare payment proposal for home health (HH) agencies [AMED, PNTG, BTSG, ADUS, AVAH, UNH], which we expect within the next two weeks based on historical patterns, we think it is more…

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June 16, 2025

Medicare Advantage: Filling in RADV Blanks; HUM Has Most Contracts Targeted [HUM, UNH, CVS, ELV, CNC, ALHC]

By Beth Steindecker

Late Friday, CMS announced the latest list of Medicare Advantage (MA) contracts to be targeted for risk adjustment data verification (RADV) audits – this time for payment year (PY) 2019 – and its associated processes…

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June 13, 2025

PBMs: State Legislative Risks Persist Through Session Ends [CI, CVS, UNH, HUM, ELV, Navitus]

By Beth Steindecker

With many 2025 state legislative sessions having concluded, pharmacy benefit managers (PBMs) have – for the moment – successfully avoided various bills seeking to aggressively curb industry practices, except for a few new laws in…

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May 21, 2025

Medicare Advantage: Ramping Up RADV Audits Clearly a Threat, But Does It Head Off Other Risks? [HUM, UNH, CVS, ELV, ALHC]

By Beth Steindecker

CMS’s announcement late Wednesday to turn the dial up on its risk-adjustment data verification (RADV) audits of Medicare Advantage (MA) contracts with an eye toward the entire landscape raises legitimate fears of recouping sizable past…

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May 19, 2025

Expected Federal Report on Fertility Benefits: Regulatory Recommendations Likely Incremental [PGNY]

By Beth Steindecker

Since we are at the 90-day mark after February 18 release of the White House’s Executive Order (EO) supportive of in-vitro fertilization (IVF), there is a hope that the Trump administration’s anticipated report of potential…

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