Compliance & Legal
The complaint charges Cigna with encouraging diagnoses that yielded higher reimbursement for MA members.
Blue Shield criticized DHCS for intending to award contracts to national, for-profit companies, singling out Kaiser Permanente in particular.
The court estimates the alleged overpayments far exceeded $100 million over a span from 2014 to 2018.
There is a widespread inability to support the access, exchange and use of electronic health information, the groups say.
Centene made no admission of liability and maintained its business practices are lawful.
The groups indicate further court action is coming due to continued problems with the interim and final rules.
The DOJ says it is closely reviewing the opinion to evaluate the next steps.
The AMA and other plaintiffs contend the insurer significantly underpaid claims and put patients at risk of balance billing.
Change claims editing buyer TPG is incapable of replacing the competitive intensity that currently exists, DOJ says.
UHC has filed its own lawsuit accusing the physician firm of deliberately upcoding thousands of claims.