CT's $11 Million on Consultants, Bipartisan MA Criticism, and Humana's Star Ratings Lawsuit

Hey all,

Happy hump day!  Healthcare reform may or may not happen, but the stories about government waste in healthcare spending definitely are happening—and they're about as surprising as rain in Seattle. Meanwhile, employers are conducting their own quiet audits of what's often their second-largest expense, presumably because someone finally asked where all that money actually goes. The transparency trend is encouraging, though there are still plenty of rocks left to turn over.

Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Yankee Institute) Connecticut Office of Health Strategy Spending on Consultants

Connecticut’s Office of Health Strategy (OHS) spent 84% of its $13.7 million budget—over $11.5 million—on out-of-state consultants in 2025, drawing criticism from lawmakers and healthcare advocates for inefficiency and overreliance on the Insurance Fund, which is funded by consumer-paid insurance fees. Despite its mission to reduce healthcare costs, OHS’s spending has grown significantly while its benchmark initiatives have failed to curb rising healthcare expenses, leading to bipartisan scrutiny and calls for more in-house expertise and accountability—though if you outsource all your work, oversight included, to a healthcare consultant, you really don’t have to do much yourself. Full Article

(Modern Healthcare) Medicare Advantage Oversight

Republican lawmakers, traditionally strong backers of Medicare Advantage, signaled a shift at a July 22 congressional hearing by criticizing insurer practices like “upcoding” and burdensome prior authorizations that inflate costs and limit care access. With over half of Medicare enrollees now in the program, concerns about waste and integrity have prompted bipartisan scrutiny, though legislative paths remain unclear amid broader partisan tensions. Lawmakers warned that while the program's structure should be preserved, major insurers like UnitedHealthcare, Humana, and Aetna must be held accountable to prevent further erosion of public trust. Rep. Dr. Greg Murphy (R-N.C.) commended plans like Scan Health and Alignment Health during their leaders' testimony, stating, "I applaud you all for doing it right." Full Article

(Fierce Healthcare) Humana’s Star Ratings Lawsuit Against CMS 

Humana has refiled a narrower lawsuit against the Centers for Medicare & Medicaid Services (CMS), claiming mishandled customer service call evaluations and calculation errors unfairly impacted its Medicare Advantage star ratings, just days after a previous legal challenge was dismissed. The star ratings directly influence federal bonus payments and Humana’s competitiveness, with the insurer now seeking expedited judgment before open enrollment and arguing CMS has withheld recalculation criteria and misapplied technical standards; analysts believe the lawsuit has a strong chance despite a potentially less favorable judge. Full Article