7 recent legal disputes with payers, settlements


From Anthem’s effort to overturn a court order affecting 400,000 patients at Tennessee’s Blue Cross Blue Shield sued for firing an unvaccinated employee, here are seven recent lawsuits and legal settlements, reported by Becker’s.

1. UnitedHealthcare has settled a class action lawsuit over its $10 million tiered reimbursement policy. The lawsuit alleged that the policy reduced payments to out-of-network mental health providers by 25% to 35%.

2. Anthem filed a pair of motions in Georgia to overturn a court order that required it to keep its network contract with Atlanta-based Northside Hospital System through Jan. 31. If approved, Anthem would be allowed to terminate its contract with Northside, affecting 400,000 patients.

3. New Hampshire has become the sixth state to announce a settlement with Centene regarding its subsidiaries’ management of state drug benefit services. An investigation found that inaccurate reporting resulted in at least $2.4 million in losses to the state. The state settled with Centene for $21 million.

4. United Behavioral Health, a subsidiary of the UnitedHealth Group, will have to pay $20 million after losing a legal battle in California for denying mental health claims.

5. Managed-care company Paramount Advantage said if Ohio approved a deal for Anthem to buy its state contract, it would end its ongoing legal challenge against the state’s Medicaid procurement process. . Paramount Advantage attempted to cancel Ohio’s last Medicaid contract after its bid was lost.

6. Two Anthem employees are suing Payor for allegedly charging high enrollment quotes and failing to pay the overtime required to meet them.

7. Former employee fired for allegedly violating Blue Cross Blue Shield of Tennessee’s social media policies is suing Payor for her termination. The employee was fired after raising concerns about the company’s vaccination requirement to state lawmakers.

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