A federal jury in Florida has convicted an insurance brokerage president and the CEO of a marketing company for their roles in a scheme to fraudulently enroll individuals in subsidized ACA plans to obtain commission payments from insurers. The scheme…
Legal
Horizon Blue Cross Blue Shield of New Jersey has agreed to pay $100 million to settle allegations that it fraudulently induced the state to award it a multibillion-dollar contract to administer employee health benefits and then overcharged throughout the contract’s…
Humana has filed a lawsuit against ChenMed, which operates medical centers for older patients, in Delaware over breach of contract and other alleged harms, according to a heavily redacted Nov. 7 court filing. Humana and ChenMed jointly operate JenCare Senior…
The Blue Cross and Blue Shield Association filed a lawsuit against Medical Lien Pros Nov. 5, alleging the company improperly registered the name “Anthem Blue Cross and Blue Shield.” Community Insurance Co., a plaintiff in the case, does business in…
Blue Cross and Blue Shield of Massachusetts has lost its legal challenge against CMS over the methodology used to calculate its 2025 Medicare Advantage star ratings. In a Nov. 3 ruling from the U.S. District Court for the District of…
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New York City employees and retirees — coupled with advocacy group Hands Off NY Care — filed a lawsuit in response to the city’s expected transition to a self-funded health plan, according to an Oct. 29 court document. The new…
California Attorney General Rob Bonta has reached a $34 million settlement to resolve claims that the Aliera Companies and its subsidiaries, along with Sharity Ministries, (formerly Trinity Healthshare) sold and operated sham health plans in violation of state law. The…
Wellmark Blue Cross and Blue Shield has filed a lawsuit against Iowa’s insurance commissioner, challenging the enforcement of a newly enacted state law that regulates pharmacy benefit managers and the administration of prescription drug benefits. The lawsuit, filed on Oct.…
A federal judge rejected Blue Cross Blue Shield of Rhode Island’s motion to dismiss a lawsuit over coverage of wilderness therapy, according to Oct. 14 court documents. Wilderness therapy is a mental health intervention that involves immersing young people in…
A federal judge dismissed Humana’s Medicare Advantage 2025 star ratings lawsuit with prejudice Oct. 14, according to court documents. After an earlier suit was dismissed in July, Humana filed a complaint to resurface its concerns with its star ratings. The…