- Blue Cross Blue Shield of Illinois is facing a lawsuit acusing the payer of denying gender-affirming care coverage under a self-funded health plan, thereby violating the anti-discrimination provision of the ACA. A federal judge in Washington state granted a class action against the payer Nov. 11.
- UCare is facing a lawsuit from the University of Minnesota, which alleges UCare’s proposal to expand its board of directors will diminish the university’s influence over the nonprofit health plan it created.
- UnitedHealth Group’s OptumRx agreed to pay $15 million to settle prescription drug overcharging allegations in Ohio, after denying it had reached a final agreement with the state. A lawsuit from Ohio’s attorney general alleged that the pharmacy benefit manager overcharged the state’s bureau of worker’s compensation $15.8 million from 2015 to 2018. OptumRx admits no wrongdoing or liability as part of the settlement.
- UnitedHealthcare of New England is facing a lawsuit from the ACLU of Rhode Island and the Rhode Island Public Transit Authority over a 2021 data breach that compromised the data of more than 20,000 former and current state employees.
- Cigna is being sued by the Justice Department for allegedly making its Medicare Advantage members appear sicker than they were by submitting false diagnosis codes to the government in order to receive higher reimbursement rates.
- Anthem Health Plans of Virginia is facing a lawsuit from Winchester, Va.-based Valley Health alleging the payer owes the health system $11.4 million in past-due reimbursements. Valley Health has not terminated its contract with Anthem because of potential disruption to the community, according to court documents.
- Florida can continue to bar the state’s Medicaid program from reimbursing patients for most forms of gender-affirming care. On Oct. 12, a judge denied a preliminary injunction request from transgender rights groups to stop the state’s rule from taking effect.
- ProMedica and Maumee, Ohio-based McLaren St. Luke’s hospital reached a settlement in an outstanding lawsuit, meaning the hospital will treat ProMedica’s Paramount Health Plan members in-network.
- Attorneys representing Blue Cross Blue Shield members in a $2.67 billion antitrust settlement with the BCBS Association asked a federal appeals court Oct. 5 to speed up the objection process. Four appeals to the settlement were filed Sept. 7 on behalf of six objectors, including Home Depot.
9 recent legal actions involving payers
Here are nine legal developments Becker’s has reported since Oct. 11:
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