From antitrust challenges from the federal government over proposed acquisitions, to industrywide disputes over Medicare Advantage star ratings, these are 12 key insurance industry lawsuits filed or settled in 2024:
1. UnitedHealthcare vs. CMS
In November, UnitedHealthcare prevailed in its lawsuit against CMS regarding the methodology used to calculate its 2025 Medicare Advantage star ratings. Humana, Centene, Elevance Health, and BCBS Louisiana have all raised legal challenges about the methodology CMS employed for the 2025 ratings. Some of these challenges have centered on the agency's use of "secret shopper" phone calls to assess customer service metrics. Earlier in 2024, SCAN Health Plan and Elevance Health won similar lawsuits against CMS. SCAN's lawsuit prompted CMS to recalculate star ratings for all MA plans, resulting in over $1 billion in additional payments to health plans nationwide.
2. BCBS Minnesota vs. Labor Department
A federal judge ruled in August that Blue Cross and Blue Shield of Minnesota must face a lawsuit from the U.S. Labor Department accusing the payer of incorrectly imposing a state provider tax on self-funded health plan customers and violating its fiduciary duties under ERISA.
3. UnitedHealth vs. Labor Department
UnitedHealth Group reached a settlement with the Department of Labor in October over allegations that the company's third-party administration subsidiary, UMR, improperly denied claims for emergency room visits and urinary drug screenings for thousands of patients.
4. Blue Cross Blue Shield vs. employees
BCBS Michigan and Tennessee lost in federal court for terminating employees that refused to get vaccinated against COVID-19.
5. Optum, Aetna vs. members
A lawsuit initially filed in 2015 claimed that Aetna and Optum used misleading billing practices — specifically, employing "dummy codes" to disguise administrative fees for chiropractic services as medical charges — thereby causing plan participants and their employers to pay the fees unknowingly. Aetna and Optum agreed to settle the class-action suit in November, but Optum backed out of the proposed deal in December.
6. Owens & Minor vs. Anthem
Owens & Minor filed a lawsuit against Anthem Blue Cross and Blue Shield of Virginia in November, accusing the insurer of failing to uphold its fiduciary duties under ERISA through mismanagement of its employee health plan. This lawsuit reflects a wider legal trend for employers and health plan administrators navigating ERISA requirements, including recent lawsuits from Kraft Heinz, Wells Fargo and Johnson & Johnson.
7. UnitedHealth vs. members, shareholders
UnitedHealth Group is facing a proposed securities fraud class-action lawsuit filed in May, alleging that the company failed to disclose that the Justice Department opened an antitrust investigation into the company. The investigation came into the public's attention in February when The Wall Street Journal reported that the DOJ was investigating the relationships between the company's various segments, including Optum. Neither the Justice Department nor UnitedHealth has publicly acknowledged the investigation. The lawsuit from the City of Hollywood Firefighters Pension Fund alleges that UnitedHealth was aware of the investigation since at least October 2023. A shareholder derivative lawsuit was filed against the company and its executives over the issue in July.
8. UnitedHealth vs. DOJ
The U.S. Justice Department sued UnitedHealth Group and home health company Amedisys in November over the companies' planned $3.3 billion merger and concerns of lessened competition in the home health market because the two companies are "direct competitors."
9. Blue Cross Blue Shield vs. members, providers
In June, the U.S. Supreme Court declined to hear Home Depot's challenge to a $2.67 billion settlement with Blue Cross Blue Shield companies, ending a legal saga over alleged anticompetitive behavior that dates back to 2012. Members alleged that BCBS companies conspired to divide up markets to avoid competing with each other, thereby driving up costs for consumers.
Separately, the BCBS Association, along with the 33 independent BCBS companies, agreed to pay $2.8 billion in October to settle antitrust claims from healthcare providers, marking the largest settlement of its kind in the healthcare industry.
10. UnitedHealth vs. employees
UnitedHealth Group agreed to pay $69 million in December to settle a class-action lawsuit that alleged the company prioritized its business relationship with Wells Fargo over concerns that its 401(k) plan contained low-performing target-date funds.
11. KFF Health News vs. HHS
KFF Health News sued HHS in November to force the release of audits pertaining to Medicare Advantage plans. The lawsuit is seeking correspondence between HHS officials and MA plans related to overpayment audits and financial penalties, along with copies of government contracts awarded to firms conducting audits of MA plans.
12. DOJ vs. six health plans
In March, the Justice Department sued six health system-owned insurers participating in the Uniformed Services Family Health Plan program for allegedly concealing overpayments for services provided to retired military members and their families.