Fort Lauderdale, Fla.-based Broward Health filed a lawsuit against Florida Blue and its HMO due to alleged underpayments for emergency department services, according to an April 7 state court complaint. Broward Health has been out of network for Florida Blue…
Legal
The California Hospital Association has filed a lawsuit against Anthem Blue Cross over a policy that would penalize hospitals when patients receive care from out-of-network physicians, even if the hospital is in network. The lawsuit, filed May 4 in Sacramento,…
Oregon’s Division of Financial Regulation has ordered ClearShare Health and four affiliated entities to immediately stop selling memberships in the state, concluding that the Texas-based health share operated as an unlicensed insurer and TPA. ClearShare markets itself as a health…
The Connecticut Insurance Department fined Aetna, Cigna, ConnectiCare, UnitedHealthcare and Anthem over alleged mental health parity violations, according to an April 15 department report. The report said carriers had “non-comparable and inadequate [mental health and substance use disorder] networks because…
A federal court has temporarily halted a Florida-based operation that the Federal Trade Commission alleges collected more than $91 million by deceiving consumers into purchasing fake health insurance coverage. The FTC filed its complaint April 7 in the U.S. District…
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The Montana 1st Judicial District Court is allowing State Auditor and Insurance Commissioner James Brown to move forward with his investigation of Blue Cross and Blue Shield of Montana’s Conduent data breach. In an April 16 news release, the auditor…
A federal judge in the U.S. District Court for the Middle District of Florida has dismissed an Aetna lawsuit that alleged that radiology practices routed claims to secure higher reimbursement rates. Aetna claimed Radiology Partners and Mori, Bean and Brooks…
A federal judge on April 15 denied a Canadian faith-based group’s request to force UnitedHealth Group to include a shareholder proposal in its upcoming proxy materials. The group, Mission Fund, had asked UnitedHealth’s board to publish a report describing the…
A California federal judge dismissed an Elevance Health subsidiary’s lawsuit that alleged that HaloMD and several providers conspired to exploit the No Surprises Act’s Independent Dispute Resolution process for financial gain. Anthem Blue Cross alleged that HaloMD and affiliated providers…
Priority Health is estimated to have collected at least $4.4 million in Medicare Advantage overpayments throughout 2018 and 2019, according to a March audit from the HHS Office of the Inspector General. The audit focused on 10 high-risk diagnosis groups.…