March 5, 2026 •
The 'PxDx' Algorithm: Automating Medical Necessity Denials The ‘PxDx’ system, formally known as “procedure-to-diagnosis,” represents a fundamental shift in how The Cigna Group processes medical…
February 26, 2026 •
The 2024 FTC Administrative Complaint: Core Allegations of Unfair Competition The Federal Trade Commission’s administrative complaint, filed on September 20, 2024, marked a decisive escalation…
February 22, 2026 • Ekalavya Hansaj
The NaviHealth Acquisition: Integrating AI into UnitedHealthcare's Denial Infrastructure In May 2020 UnitedHealth Group completed a strategic maneuver that fundamentally altered the mechanics of Medicare…
February 16, 2026 • Ekalavya Hansaj
The Mutual Holding Façade: Corporate Structure vs. Member Benefit In 2014, Blue Cross and Blue Shield of Florida executed a legal maneuver that fundamentally altered…
February 14, 2026 • Ekalavya Hansaj
High-Denial Algorithms: Investigating the 17% Medicaid Prior Authorization Rejection Rate The statistical architecture of modern managed care relies on a single, ruthless metric. This figure…
February 9, 2026 • Ekalavya Hansaj
The nH Predict Algorithm: AI-Driven Claim Denials and Legal Scrutiny The operational core of Humana’s cost-containment strategy for Medicare Advantage (MA) relies heavily on a…
February 8, 2026 • Ekalavya Hansaj
PBM Spread Pricing: The Billion-Dollar Markup Scheme PBM Spread Pricing: The Billion Dollar Markup Scheme Corporate entities often exploit complexity to generate profit. Pharmacy Benefit…
February 8, 2026 • Ekalavya Hansaj
Federal Kickback Probe: The DOJ Lawsuit on Medicare Advantage Broker Schemes Federal Kickback Probe: The DOJ Lawsuit on Medicare Advantage Broker Schemes ### The Pay-to-Play…
February 7, 2026 • Ekalavya Hansaj
The Vertical Trap: Antitrust Implications of the Optum-UnitedHealthcare Nexus The following investigative review section examines the antitrust implications of the Optum-UnitedHealthcare alignment. UnitedHealth Group operates…
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