Legal & Regulatory Issues

Centene settled two alleged overpayment disputes with Arkansas and Illinois, totaling over $72 million in payouts. 

Negotiations are coming down to the wire as UnitedHealthcare and Marietta, Ga.-based Wellstar Health System have yet to reup a contract ahead of an Oct. 3 deadline. 

UnitedHealthcare is among the payers involved in a legal battle over New York City's decision to shift retirees' healthcare coverage off of Medicare and onto a new contract with Empire Blue Cross Blue Shield and EmblemHealth's joint venture, the Alliance.

A physician formerly licensed in Pennsylvania pleaded guilty to charges relating to illegally distributing controlled substances and filing false tax returns, according to a Sept. 28 release from the Justice Department. 

The Justice Department charged six physical therapists and two acupuncturists in relation to a $20 million healthcare fraud scheme for allegedly paying patients to falsely bill payers for services never rendered and faking medical documents.

AmerisourceBergen, Cardinal Health and McKesson said Sept. 28 they will pay a collective $75 million to the Cherokee Nation to settle opioid litigation. 

The Organization of Public Service Retirees, which includes over 4,000 retired New York City public servants, is suing the city over its recent Medicare contract with Alliance.

Humana filed a lawsuit Sept. 24 against drugmaker Biogen for allegedly inflating both the number and price of prescriptions for three multiple sclerosis drugs.

Blue Cross Blue Shield of Michigan is refuting claims that it should be the target of a lawsuit accusing it of cutting reimbursement rates for substance use disorder treatment during an opioid epidemic. 

A federal judge has denied a request by workers at Edgewood, Ky.-based St. Elizabeth Healthcare to prohibit enforcement of the system's COVID-19 vaccine mandate, according to court documents.