Compliance & Legal
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.
UnitedHealth has also filed a lawsuit, and Elevance says it is considering its options.
CEO Gail Boudreaux says cut points are a large factor driving the decline of plans rated four stars or higher.
The payment is the largest in a healthcare antitrust case, providers say, and settles 12 years of litigation.