From UnitedHealth Group defeating the Justice Department's challenge of its Change Healthcare acquisition to the approval of a $2.67 billion Blue Cross Blue Shield antitrust settlement, here are 10 key court cases involving payers that Becker's reported in 2022:
1. 'False and invalid diagnoses': DOJ sues Cigna for alleged Medicare Advantage fraud
The Justice Department filed a lawsuit Oct. 17 alleging Cigna made its Medicare Advantage members appear sicker than they were by submitting false diagnosis codes to the government to receive higher reimbursement rates.
2. Blue Shield of California files lawsuit seeking public records in Medi-Cal dispute
Blue Shield of California filed a lawsuit Oct. 7 alleging that California violated public records laws by not releasing documents related to the state's Medicaid contract awards. The suit comes after Blue Shield lost Medi-Cal contracts in all 13 counties in which it bid.
3. Judge signs off on UnitedHealth-Change deal, rejects DOJ challenge
UnitedHealth Group was able to complete its $7.8 billion acquisition of Change Healthcare after a Washington, D.C., federal judge sided Sept. 19 with the company over the Justice Department's challenge of the deal. The Justice Department plans to appeal the ruling.
4. UnitedHealth CFO named in class-action lawsuit over 401(k) plan
UnitedHealth Group CFO John Rex was added Aug. 24 to a class-action lawsuit alleging he put the company's business relationship with Wells Fargo ahead of information the company's 401(k) plan was filled with low-performing target-date funds.
5. Federal judge gives final approval to $2.67B BCBS antitrust settlement
A federal judge in Alabama on Aug. 9 approved a final settlement of $2.67 billion with Blue Cross Blue Shield companies following a decadelong legal battle over alleged anticompetitive behavior that negatively affected members. The final approval includes mandating the insurers drop a BCBS Association rule that requires two-thirds of national net revenues from health plans and related services to come from Blue-branded products.
6. Supreme Court rejects UnitedHealthcare appeal of Medicare Advantage overpayment rule
The Supreme Court on June 21 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 stems from whether CMS must ensure there is actuarial equivalence between Medicare Advantage payments and traditional fee-for-service Medicare payments.
7. Oscar Health concealed COVID-19 financial woes before IPO, investor lawsuit claims
An Oscar Health stockholder filed a proposed class action May 12 in the Southern District Court of New York, alleging the insurtech company misled investors about financial issues caused by COVID-19 ahead of its initial public offering in March 2021.
A Delaware judge dismissed a lawsuit from Cigna shareholders April 7 that claimed executives with the company fumbled a $1.85 billion termination fee following the failed $54 billion merger with Anthem in 2017.
9. Centene wins lawsuit from shareholders over Health Net purchase
The 8th Circuit Court of Appeals ruled April 7 that Centene shareholders cannot sue the payer or its directors for allegedly withholding information about its 2016 purchase of Health Net for $6.8 billion.
10. Appellate court reverses class-action win in UnitedHealth reprocessing case
A federal appellate court on March 22 reversed a pair of lower court decisions that required UnitedHealth Group's behavioral health unit to reprocess 67,000 previously denied mental health and substance abuse claims.