Legal

Elevance Health filed a complaint Sept. 12 against a former senior underwriting executive who took another job at a competitor despite having signed a noncompete agreement. According to the lawsuit, which was reviewed by Becker’s, Maria Gregory started a position…

The Arizona Department of Insurance and Financial Institutions has ordered RespondersHealth to cease and desist its insurance business in the state, as the company is unauthorized to sell health insurance. According to the Aug. 22 order, in early 2025, the…

A federal judge in Minnesota has denied UnitedHealth Group’s request to narrow the scope of discovery in an ongoing lawsuit that accuses the insurer of using artificial intelligence to wrongfully deny Medicare Advantage members post-acute care. The case, filed in…

CVS Caremark will pay $32.1 million to the state of Oklahoma after the pharmacy benefit manager allegedly held back savings from the state’s employee health plan, according to a Sept. 9 news release from Oklahoma Attorney General Gentner Drummond. The…

A settlement has been finalized in a decadelong lawsuit that claimed Aetna and Optum used misleading billing practices to conceal administrative fees for chiropractic and physical therapy services as medical charges. Chief Judge Martin Reidinger of the federal Western District…

UnitedHealthcare is suing Radiology Partners and its Arizona-based affiliate, Sonoran Radiology, alleging the companies have been “abusing” the No Surprises Act’s independent dispute resolution process and “funneling millions into the pockets of its private-equity owners.” The complaint, filed Aug. 8…

MVP Health Plan has agreed to overhaul its mental health provider directory as part of a settlement with the New York Attorney General’s Office.  The settlement follows an investigation from the office that uncovered systemic issues with MVP’s network, including…

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…

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…