10 recent legal actions involving payers

Here are 10 recent legal actions involving payers:

1. New York Attorney General Letitia James' office announced that a settlement administrator has completed $13.6 million in payments to consumers who were denied mental healthcare coverage by UnitedHealthcare. 

2. A federal judge in California approved a class-action settlement requiring Anthem Blue Cross to reprocess claims for eating disorder treatments or pay up to $5,500 for denied claims. 

3. A proposed class action in the U.S. District Court for the Northern District of Illinois alleges that Blue Cross Blue Shield of Illinois unlawfully denied full coverage for fertility treatments to LBGTQ members. 

4. A federal judge in Pennsylvania approved a class-action lawsuit against Aetna for allegedly violating the Employee Retirement Income Security Act by forcing disability benefits recipients to return their personal injury payments. 

5. The U.S. Labor Department is suing Atlanta-based Aliera Companies and its CEO, Shelley Steele, for allegedly violating the Employee Retirement Income Security Act by paying themselves and affiliated companies with health plan assets.

6. East Liverpool City Hospital in Ohio is suing Aetna over allegations the insurer refused to pay, or substantially underpaid, for hundreds of medical services provided to in-network Aetna members without valid reasons for doing so. 

7. Deerfield Beach, Fla.-based payer Health Option One accused five businesses who sell or market health plans of unlawfully providing policies associated with Native American tribes to circumvent state laws. 

8. New Mexico medical cannabis company Top Organics-Ultra Health and six medical patients have filed a proposed class action against seven payers they say should be covering medical cannabis costs as a behavioral health service. The payers named in the lawsuit are Blue Cross and Blue Shield of New Mexico, True Health New Mexico, Cigna, Molina Healthcare of New Mexico, Presbyterian Health Plan, Presbyterian Insurance and Western Sky Community Care.

9. Molina Healthcare and former subsidiary Pathways of Massachusetts agreed to pay a settlement of $4.62 million over allegations of False Claims Act violations and improper licensure and supervision of healthcare employees. Federal and state officials alleged that the two entities improperly submitted reimbursement claims to the state's Medicaid program, MassHealth, and associated organizations.

10. The U.S. Supreme Court declined to hear UnitedHealthcare's appeal of a CMS rule meant to recoup Medicare Advantage overpayments from payers. The federal rule, first implemented in 2014, requires a payer to refund payments to CMS within 60 days if it learns a diagnosis lacks medical record support. The argument stemmed from whether CMS must ensure there is actuarial equivalence between Medicare Advantage payments and traditional fee-for-service Medicare payments.

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