Payer
HaloMD says No Surprises is lowering spending on emergency care. Researchers aren’t convinced.
HaloMD, a major player in surprise billing disputes, released a report claiming the No Surprises Act has cut out-of-network emergency care spending by billions. However, researchers from Georgetown and Brookings question the assumptions and data behind these estimates, noting potential conflicts of interest.
Medicare spent hundreds of millions of dollars on ineligible drugs, audit finds
An HHS OIG audit shows that Medicare Part D paid $587.7 million between 2021 and 2023 for five drugs that had been switched to over-the-counter status, primarily involving generic versions of Voltaren. CMS's reliance on outdated FDA data and failure to promptly notify plans led to increasing non-compliant payments each year. The OIG recommended that CMS issue timeframes similar to the FDA's, and CMS has agreed.
UnitedHealthcare cuts prior authorization from 1,700 codes
UnitedHealth Insurance announced that starting in October, it will eliminate prior authorization requirements for approximately 1,700 medical codes, covering commercial, Medicare Advantage, Medicaid, and ACA plans, accounting for about 30% of its total prior authorizations. This move aims to respond to public dissatisfaction with administrative barriers and to address regulatory pressure.
Employee healthcare costs expected to rise nearly 10% in 2027, employers face dual pressure of benefits and finances
According to the latest Aon research, the average healthcare cost per employee for U.S. employers in 2027 is expected to exceed $19,000, up 9.5% year-over-year, marking the fourth consecutive year of near-double-digit increases. Employee out-of-pocket costs have also risen significantly, reaching an average of $5,297 per person in 2026. The cost surge is driven by the high prevalence of chronic diseases, the adoption of specialty drugs and GLP-1 therapies, and AI-assisted clinical coding inflating bills. Employers face a dilemma between benefit budgets and salary growth.
Elevance Behavioral Health Welcomes New President
Carelon Behavioral Health, a division of Elevance, announced that Dr. Patrick Fox has assumed the role of president effective immediately, succeeding Corbin Petro. Fox brings thirty years of clinical psychiatry and behavioral health leadership experience and previously served as president of Wellpoint New Jersey. Concurrently, Patrick Gillespie has taken over as president of Wellpoint New Jersey.
R1 Acquires Humata Health to Bolster AI-Driven Prior Authorization Capabilities
Revenue cycle management firm R1 announced an agreement to acquire Humata Health, a company focused on AI-powered prior authorizations. The deal, expected to close in Q3, will integrate Humata's technology into R1's platform, aiming to reduce administrative burden and improve approval rates.
Humana Appoints Physician Executive Dr. Shantanu Nundy as Chief Medical Officer
Humana announced Thursday that Dr. Shantanu Nundy will become its chief medical officer, effective Aug. 31. Nundy, who previously served as executive vice president of care delivery and chief health officer at Accolade, will bring a clinical perspective to product design, platform development, and AI use. He replaces Kate Goodrich, who left in October 2025 for a role at UnitedHealth. The appointment comes as Humana focuses on margin improvement and operational efficiency.
Epic Launches Real-Time Prior Authorization Checks Across Four Health Systems
Epic has deployed a new API that lets clinicians instantly check if prior authorization is required for medical treatments, initially adopted by four health systems. The tool aligns with federal interoperability rules and aims to reduce administrative burden.
First-of-Its-Kind Data Reveals Wide Variation in Insurer Prior Authorization Denial Rates
KFF's analysis of first-ever public prior authorization metrics finds average denial rates of 12% in Medicare Advantage, 14% in Medicaid managed care, and 18% in ACA marketplaces, with wide variation among insurers. The data also reveals that appeals often succeed but are rarely pursued.
Brookings analysts: CMS work-rule impact estimates built on 'invented evidence'
A Brookings Institution analysis contends that the CMS rule implementing Medicaid work requirements rests on 'complete random assumptions' with no empirical justification. The report challenges the agency's estimates that 29% of affected beneficiaries will find work, that only 3.1-3.3 million will lose coverage over a decade, and that the policy will save $350.3 billion — figures that diverge sharply from CBO forecasts and prior studies.