A coalition of 21 Democratic-led states are suing HHS and CMS over new ACA rules they allege would impose significant barriers to receiving health coverage. The lawsuit, filed July 17 in the U.S. District Court for the District of Massachusetts,…
Legal
California’s insurance commissioner has issued a cease and desist order against Innovative Partners for illegally acting as an insurer in the state and offering health coverage without proper certification. The state also served 10 additional cease and desist orders to…
AdventHealth’s Shawnee Mission Medical Center is suing Blue Cross and Blue Shield of Kansas City, alleging the insurer improperly withheld more than $2 million in payments by denying hundreds of valid medical diagnoses submitted by the hospital’s physicians. The lawsuit,…
Blue Cross and Blue Shield of Louisiana has lost its legal challenge against CMS over how its 2025 Medicare Advantage star ratings were calculated. On July 9, the U.S. District Court for the District of Columbia ruled that CMS acted…
Justice Department officials have questioned former UnitedHealth Group employees as part of an investigation into the company’s Medicare Advantage billing practices, The Wall Street Journal reported July 9. The Journal first reported in May that the company was under criminal…
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A federal court has partially ruled in favor of Alignment Healthcare in a legal challenge against CMS, resulting in the Medicare Advantage company’s Arizona HMO star rating being raised from 3.5 to 4 stars. All of Alignment’s members are now…
A Minnesota judge has ruled against UnitedHealthcare in a lawsuit challenging a Minnesota law barring for-profit insurers from the state’s Medicaid program. In a decision issued June 30, Minnesota District Court Judge Mark Ireland ruled the statute, passed as part…
A former Medicare Advantage executive has been found not guilty of healthcare fraud. A jury found Kenia Valle Boza, the former director of Medicare risk adjustment analytics for HealthSun Health Plans, not guilty of one count of conspiracy to commit…