A federal appeals court has handed a win to Cigna, affirming the dismissal of a class action lawsuit that alleged the insurer’s exclusion of weight loss drug coverage amounted to disability discrimination against members with obesity. The U.S. Court of…
Legal
An insurance brokerage president and the CEO of a marketing company were each sentenced to 20 years in prison for their roles in a scheme to fraudulently enroll individuals in subsidized ACA plans to obtain commission payments from insurers. What…
Justice Department sues OhioHealth for allegedly blocking lower-cost health plans — 4 things to know
The Justice Department and the state of Ohio on Feb. 20 filed a civil antitrust lawsuit against OhioHealth, alleging the system used anticompetitive contract provisions to drive up healthcare costs for patients and employers in central Ohio. Four things to…
Two Connecticut cities filed federal lawsuits against Cigna, CVS Health and UnitedHealth Group — targeting their pharmacy benefit managers — over an alleged “insulin pricing scheme,” according to January filings in the U.S. District Court for the state. Along with…
EmblemHealth will pay $2.5 million after an investigation by the New York attorney general’s office found the insurer violated parity laws and failed to ensure access to mental healthcare services because of inaccurate listings, also known as “ghost networks.” The office launched…
Advertisement
UCare is in the throes of a state takeover in Minnesota, with health systems and former employees voicing concerns over the insurer’s rehabilitation. The insurer posted an operating loss of $504 million in 2024 and shared plans to exit the…
Nevada identified insurer violations of mental health laws based on nonquantitative treatment limitations, according to a Dec. 31 report from the state’s insurance division. To better understand adherence to the Mental Health Parity and Addiction Equity Act, reviewers requested information…
A former senior director of data analytics at Optum was found guilty of defrauding the company out of more than $1.2 million through a scheme involving a fraudulent hire and salary kickbacks. What happened? What’s next?
The trustee overseeing litigation claims for bankrupt Dallas-based Steward Health Care System is suing five payers, alleging they owe the system’s former hospitals at least $56.9 million in unpaid claims. The trustee, Mark Kronfeld, filed the complaints Feb. 10 and…
The Washington State Court of Appeals ruled that Zion HealthShare, a medical cost-sharing nonprofit, is operating as an insurer, according to a Feb. 5 filing. Zion HealthShare calls itself “an affordable, community-driven alternative to traditional health insurance.” Because Zion was…