Health Plan Weekly

Managed Medicaid health plans are an important partner to states for detecting fraud, waste and abuse in Medicaid, according to the panelists of a webinar sponsored by KFF. Yet what exactly constitutes fraud, waste and abuse has become a political flashpoint. 

House Republicans’ budget resolution calls for the Energy and Commerce Committee, which oversees Medicaid, to cut spending by $880 billion over 10 years — much of which likely will come from Medicaid. House Speaker Mike Johnson (R-La.) asserted in February that “if you eliminate fraud, waste and abuse in Medicaid, you’ve got a huge amount of money that you can spend on real priorities for the country.”  

However, the KFF webinar speakers are skeptical of that claim. 

Here’s how major health insurers’ stock performed in April 2025. UnitedHealth Group had the highest closing stock price among major commercial insurers as of April 30, 2025, at $420.58. Humana Inc. had the highest closing stock price among major Medicare insurers at $262.24.

Roberto Faller, an investor in UnitedHealth Group, filed a proposed class action lawsuit on May 7 alleging UnitedHealth withheld information about the backlash related to its response to the December killing of UnitedHealthcare CEO Brian Thompson, CBS News reported. Faller alleges that UnitedHealth “artificially inflated prices” of its shares when it provided financial guidance in December and reaffirmed the projections the next month. In April, UnitedHealth lowered its guidance and saw its shares decline by more than 22% following disappointing first-quarter earnings results. Faller is asking a judge in the Southern District of New York to certify the lawsuit as a class action lawsuit.  

During the week of May 12, the House Energy and Commerce Committee plans to mark up a bill that includes drastic cuts to Medicaid, Politico reported. The news outlet said one of the major issues is how far Republicans will go in capping Medicaid payments from the federal government to states. Committee chairman Brett Guthrie (R-Ky.), House speaker Mike Johnson (R-La.) and other House GOP leaders recently met with President Donald Trump about Medicaid proposals, according to Politico. 

The Dept. of Justice (DOJ) on May 1 said it filed a complaint accusing CVS Health Corp.’s Aetna, Elevance Health, Inc. and Humana Inc. of paying “hundreds of millions of dollars in illegal kickbacks” to three large brokers in exchange for enrolling people into the insurers’ Medicare Advantage plans. 

The lawsuit was originally filed in 2021 by a former eHealth employee, Andrew Shea, under the whistleblower provisions of the False Claims Act. Gregg Shapiro, the attorney representing Shea, tells AIS Health, a division of MMIT, that “Mr. Shea is grateful that the Department of Justice thoroughly investigated his allegations and has chosen to intervene in the case.” 

Shapiro added: “People with Medicare must know that when an insurance agent recommends a plan, that recommendation is based solely on the client's individual needs and preferences. Mr. Shea looks forward to seeing this matter through to a just conclusion.” 

Two recent studies have shown that capping per-enrollee spending for the Medicaid expansion population — which Republicans are reportedly discussing — could shift billions in costs to states.

The U.S. House of Representatives on April 10 voted 217-215 to adopt a fiscal year 2026 budget resolution that calls for up to $880 billion in Medicaid cuts to help pay for President Donald Trump’s tax cuts. The House Energy and Commerce Committee, which has jurisdiction over Medicaid, is expected to mark up its portion of budget reconciliation legislation on May 7.