Compliance & Legal
HRSA informed J&J in August that its rebate model was inconsistent with the 340B statute.
The merger would further consolidate UnitedHealth's standing as the dominant force in the American healthcare system, lawsuit says.
Insured customers paid more for drugs than members of its Prescription Savings Club, lawsuit alleges.
Star ratings represent billions of dollars in quality bonus payments. CMS has cost Elevance $375M, the complaint says.
CMS is finalizing a new specific wage index that will be used to adjust payments for geographic differences in area wages.
Ivor Jallah, 37, pleaded guilty earlier this year and has been sentenced to 120 months in federal prison.
According to the AMA, this has undercut fair payment for out-of-network healthcare services and eliminated market competition.
To the surprise of many patients, most of the doctors in this network don't accept their insurance plan, lawsuit alleges.
The star rating drop will cause Centene to lose an estimated $73M in gross revenue, lawsuit says.
The Tukey outlier, guardrails on cut points and the end of Chevron are factors that may influence payer challenges to low 2025 MA star ratings, says Jenn Kerfoot, chief strategy and growth officer at DUOS.