Department of Justice

UnitedHealth Group Scrutinized for Alleged Antitrust Practices

February 28, 2024 - The Department of Justice (DOJ) is investigating antitrust allegations against UnitedHealth Group, with a specific focus on the ties between UnitedHealthcare and Optum, according to a Wall Street Journal article that broke the story. Optum’s physician group acquisitions are at the center of DOJ’s inquiries as well as how the...


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Elevance Health’s $2.5B Acquisition of BCBSLA Paused a Second Time

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DOJ Intervenes in Whistleblower Cases Alleging Medicare Fraud

by Kelsey Waddill

The Department of Justice (DOJ) will intervene in the case of six whistleblower lawsuits against Kaiser Permanente regarding Medicare Advantage diagnosis codes and alleged Medicare fraud. The lawsuits...

Perpetrators of National ACA Enrollment Fraud Case Sentenced

by Kelsey Waddill

Update 3/3/2021: This article has been updated to reflect that Jeffrey Yates was indicted as having participated in the Whites' fraud scheme. A previous version said that he was...

DOJ Supports the Affordable Care Act in Supreme Court Case

by Kelsey Waddill

The Department of Justice has backed down from its opposition to the Affordable Care Act, a letter from the Department of Justice to the Supreme Court announced. “Following the change in...

Humana, Roche Settle False Claims Act Lawsuit, Agree to Pay $12.5M

by Kelsey Waddill

An Anti-Kickback and False Claims Act lawsuit against Humana and Roche Diagnostics Corp. and Roche Diabetes Care, Inc. (Roche) has finally come to a close, Sanford Heisler Sharp, LLP announced. The...

BCBSA Settles Anti-Trust Litigation for $2.7B, Anthem Pays 22%

by Kelsey Waddill

Blue Cross Blue Shield Association (BCBSA) has nearly concluded an eight-year-long anti-trust litigation with a $2.67 billion settlement, according to court documents which the Office of the Insurance...

AMA: 56% Increase in Payer Market Consolidation In Past 5 Years

by Kelsey Waddill

Payer market consolidation has been increasing over the past five years and this consolidation is having negative effects on consumers, the American Medical Association (AMA) asserted in its latest...

DOJ Launches Lawsuit Against Anthem for Risk Adjustment Fraud

by Kelsey Waddill

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Oscar Appeals Dismissal of Anti-Trust Lawsuit Against Florida Blue

by Kelsey Waddill

Oscar Insurance Company of Florida (Oscar) has appealed the federal court’s dismissal of the company’s anti-trust lawsuit against Florida Blue, the company announced in an emailed...

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by Kelsey Waddill

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Payer Industry Consolidation Threatens Independent Providers, Premiums

by Kelsey Waddill

Seventy-five percent of the payer industry is made up of highly concentrated markets, a number that has been rising since 2014, an American Medical Association (AMA) study found. And in turn, public...

Sutter Health to Pay $30M in Medicare Advantage Settlement

by Jessica Kent

Sutter Health, a California-based, non-profit benefit organization, has agreed to pay $30 million to settle allegations that its affiliated entities submitted false information about the health status...

Atrium Settlement Ends Steering Restrictions in Payer Contracts

by Kyle Murphy, PhD

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by Thomas Beaton

BlueCross BlueShield (BCBS) of Tennessee has been named a damaged party after it was defrauded $2 million as part of a larger $2 billion telemedicine insurance scheme, according to the Department of...

$36.9M in Medicare Fraud Leads to Federal Convictions, Sentencing

by Thomas Beaton

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by Thomas Beaton

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Aetna Sells Portion of Medicare Business to Fast-Track CVS-Aetna

by Thomas Beaton

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by Thomas Beaton

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by Thomas Beaton

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