Jacksonville, Fla.-based management services organization Complete Health Partners Holdings has agreed to pay $14.1 million to settle allegations that it violated the False Claims Act by causing false diagnosis codes to be submitted to boost Medicare Advantage payments. The settlement…
Legal
Five federal employees are suing U.S. Office of Personnel Management Director Scott Kupor over alleged sex discrimination due to the rollback of coverage for gender-affirming care. Plaintiffs, backed by the Human Rights Campaign Foundation, filed the lawsuit Aug. 3 in…
A federal judge has ruled that Blue Cross Blue Shield of Michigan must face a proposed class action accusing it of profiting from billing mistakes at the expense of the employers whose health plans it administers. Judge Robert Jonker of…
The No Surprises Act, passed in 2020 and implemented in 2022, was designed to protect patients from unexpected out-of-network medical bills. It also established the federal independent dispute resolution (IDR) process, allowing out-of-network providers and health plans to resolve payment…
A federal judge on July 29 denied a request from 25 states and Washington, D.C., to temporarily block parts of the Trump administration’s Medicaid work requirement rule. Six things to know: 1. U.S. District Judge Richard Stearns denied the states’…
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A Pennsylvania federal judge ruled that four of the five claims in a lawsuit alleging Cigna violated privacy protections through third-party vendors using tracking technologies on its website can proceed. The complaint dates to May 2025, with the most recent…
Health systems are suing insurers over what they describe as systematic underpayment and unilateral policy changes that reduce reimbursement, while insurers have been turning to the courts to accuse hospitals of gaming the No Surprises Act’s arbitration process. Layered on…
Excellus BlueCross BlueShield must face claims of race discrimination and retaliation brought by a former contract negotiation director, according to a July 22 federal court order. U.S. District Court Judge Anthony Brindisi denied Excellus’ motion for summary judgment and allowed…
A former employee of Cambia Health Solutions has accused the Portland, Ore.-based company of violating the False Claims Act by knowingly submitting inaccurate diagnosis data to CMS and failing to return Medicare Advantage overpayments. The whistleblower complaint, originally filed in…
A former vice president at Centene filed an age discrimination lawsuit against the company July 21. Kay Timmerman filed the complaint in the St. Louis County Circuit Court. The filing said Ms. Timmerman was 59 years old. In August 2025,…