Express Scripts, the pharmacy benefit manager under Cigna’s Evernorth Health Services, filed a federal lawsuit June 12 against Tennessee officials regarding the state’s Freedom, Access and Integrity in Registered Pharmacy Act, also known as the FAIR Rx Act. According to…
Legal
The Fourth Circuit Court of Appeals ruled that skilled nursing facility operators facing civil monetary penalties from CMS have no constitutional right to a jury trial. Here is what to know. 1. The June 5 ruling came in Sligo Creek Center…
A District of Columbia federal judge dismissed a lawsuit, proposed as a class action, June 10 that challenged denials of Zepbound to treat obstructive sleep apnea. The lawsuit, filed by Martin Hamburger, alleged denials by the pharmacy benefit manager CVS…
Elevance Health is suing a former senior executive, alleging he violated a noncompete agreement when he joined Medicare Advantage insurer Alignment Healthcare weeks after resigning. The complaint was filed June 5 in an Indiana federal court and names Shane Hochradel,…
Chicago-based GoHealth has filed for Chapter 11 bankruptcy as part of a prepackaged restructuring plan supported by its lenders and major equity holders. Five things to know: 1. GoHealth, a health insurance marketplace and Medicare-focused digital health company, said the…
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Lifepoint Corporate Services — affiliated with Brentwood, Tenn.-based Lifepoint Health — joined multi-district litigation by providers against MultiPlan, now Claritev, and insurers for allegedly driving underpayments. Lifepoint’s complaint, filed June 2 in an Illinois federal court, targets Aetna, Blue Cross…
A coalition of cities, physicians and small businesses are challenging recently finalized changes to the ACA marketplace they argue will cause at least 3 million people to lose health coverage, marking the latest in a series of legal challenges to…
Two health plan vendors providing in-home and mobile health services, along with the founder of one of the firms, have agreed to pay a combined $56.5 million to resolve federal allegations that they submitted false diagnosis codes to inflate Medicare…
Highmark has filed a lawsuit against medical billing company HaloMD and neuromonitoring provider Bromedicon, alleging they exploited the No Surprises Act’s independent dispute resolution process through hundreds of ineligible filings and fabricated negotiation documents. The complaint, filed June 1 in…
Arizona Attorney General Kris Mayes accused healthcare data company MultiPlan, rebranded as Claritev, and eight health insurers of a price-fixing scheme. The complaint, filed in state court, alleged MultiPlan — along with Aetna, Cigna, UnitedHealth Group, Humana, Elevance Health, Health…