A federal judge has paused portions of a new ACA rule that were set to take effect on Aug. 25, which included stricter eligibility verifications and limitations on premium subsidies. “Eliminating coverage for an estimated 1.8 million people will drive…
Legal
Troy Health, a North Carolina-based Medicare Advantage insurer, has entered into a non-prosecution agreement with the Department of Justice after admitting to a scheme involving fraudulent Medicare enrollments and identity theft. The company used automation and artificial intelligence software to…
A federal judge in Texas has struck down portions of a rule governing Medicare Advantage broker and marketing payments, siding with agent groups that challenged the regulation put into place last year. On Aug. 18, U.S. District Judge Reed O’Connor…
A federal judge has approved a $2.8 billion settlement resolving antitrust claims brought by healthcare providers against the Blue Cross Blue Shield Association and its independent entities, ending more than a decade of litigation. The settlement was approved Aug. 19…
Providence hospitals across California are the latest to sue Kaiser Permanente over allegations that the organization’s health plan has underpaid for emergency and post-stabilization care provided to Kaiser members. The Providence complaint reviewed by Becker’s was filed April 11 in…
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A SelectQuote shareholder has filed a proposed class action lawsuit against the insurance broker and its top executives, alleging the company misled investors about its operations and financial health amid a Department of Justice investigation. In May, the DOJ filed…
UnitedHealth Group is complying with criminal and civil investigations into its Medicare Advantage business, the company said in a July 24 regulatory filing. The disclosure comes after The Wall Street Journal reported in May that the Justice Department has been…
Humana has reintroduced a lawsuit challenging its Medicare Advantage star ratings. On July 18, U.S. District Judge Reed O’Connor dismissed the case without prejudice. Mr. O’Connor ruled that Humana had not exhausted all of its administrative appeal options when it…
Attorneys representing Luigi Mangione, the man accused of killing UnitedHealthcare CEO Brian Thompson in late 2024, have accused the Manhattan District Attorney’s Office of improperly obtaining over 120 pages of confidential medical records from Aetna, Mangione’s health insurer. In a…
A judge has dismissed Humana’s lawsuit challenging its Medicare Advantage star ratings. In a July 18 order, U.S. District Judge Reed O’Connor dismissed the case without prejudice, meaning it could be reintroduced. In his filing, Mr. O’Connor wrote that Humana…