Reimbursement
The star rating drop will cause Centene to lose an estimated $73M in gross revenue, lawsuit says.
The payment is the largest in a healthcare antitrust case, providers say, and settles 12 years of litigation.
Humana blames higher industry cut points and one contract decreasing to a 3.5-star rating from a 4.5-star rating in 2024.
The drugmaker says it believes the rebate model is legally permissible and needed to improve the integrity of the 340B program.
Payments to insurance agents incentivize them to base referrals on financial considerations, DOJ says.
The drug company faces civil monetary penalties and the termination of its Pharmaceutical Pricing Agreement.
This is an 8% decline following the expiration of pandemic-era policies that temporarily increased star ratings for some plans.
Eighty hospitals want a reversal of a final rule that includes Medicare Advantage in payment calculations.
Compensation increased more than 5% for many specialties but only increased 3.6% among primary care specialties.
