On April 16, a Florida federal judge dismissed Aetna's fraud suit against Radiology Partners and Mori, Bean and Brooks with prejudice. Judge Brian J. Davis said Aetna plausibly alleged fraud but failed to show it could not have challenged the billing conduct during No Surprises Act arbitration. The complaint alleged RP routed other Florida practices' claims through MBB, producing tens of thousands of disputes and millions in awards. In one example cited by the court, IDR produced a $752 payment versus a $78.89 in-network fee. For plans, the lesson is blunt: contest suspect billing inside IDR, because a later do-over may not exist.

Oregon placed ATRIO Health Plans under immediate supervision on April 13 after the MA insurer reported a $52.0 million 2025 operating loss. Regulators also cited a provider claims backlog and adjusted Dec. 31, 2025 capital and surplus down to $9.8 million after disallowing $75.7 million of related-company receivables. The 60-day order gives the state control over asset transfers, new debt, investments, and reinsurance contracts. For MA finance teams, a $52 million loss against $9.8 million of adjusted surplus leaves little room for reserve misses or provider-payment delays.

Medicaid insurers are stepping up outreach before federal work requirements start January 1, 2027, even as CMS implementation details are still pending. Reuters reported April 13 that Aetna is already connecting some Medicaid members with job opportunities, while states wait for June guidance. CMS told states in December that $200 million in FY 2026 funding will support systems work, but managed care plans cannot determine compliance. For plans, the math is straightforward: less disenrollment preserves PMPM revenue, and affiliated Marketplace products offer a backup landing spot when Medicaid churn starts.