PBMs take Tennessee, Illinois to federal court over pharmacy laws
(By: Elizabeth Casolo for Becker’s Hospital Review ) The Pharmaceutical Care Management Association, a trade group for pharmacy benefit managers,
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Legal Actions/Court Decisions
CMS recalculates MA star ratings payments in wake of Clover lawsuit
(By: Elizabeth Casolo for Becker’s Hospital Review ) CMS is “voluntarily recalculating” 2027 Medicare Advantage quality bonus payment ratings, based
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Health systems sue CVS over alleged $250M 340B scheme
(By: Alan Condon for Becker’s Hospital Review ) Three health systems have filed federal lawsuits against CVS Health, alleging the
Read More Healthcare software company owner convicted in $1B Medicare fraud scheme
(By: Naomi Diaz for Becker’s Hospital Review ) A federal jury in the Southern District of Florida convicted the founder
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CMS issues another round of Medicare Advantage fines to 13 health plans
(By: Jakob Emerson for Becker’s Hospital Review ) CMS has fined 13 health plans a combined $1.5 million for Medicare
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Oregon declares health share company an unlicensed insurer, orders it to cease operations
(By: Jakob Emerson for Becker’s Hospital Review ) Oregon’s Division of Financial Regulation has ordered ClearShare Health and four affiliated
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Connecticut fines 5 insurers over alleged mental health parity violations
(By: Elizabeth Casolo for Becker’s Hospital Review ) The Connecticut Insurance Department fined Aetna, Cigna, ConnectiCare, UnitedHealthcare and Anthem over
Read More 7 recent payer fines from states
(By: Jakob Emerson for Becker’s Hospital Review ) Payers have faced state penalties in 2026 for slow reimbursements, mishandled member
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Louisiana bill would require human review of AI-driven coverage denials
(By: Jakob Emerson for Becker’s Hospital Review ) Louisiana lawmakers are advancing a bill that would restrict how payers use
Read More Missouri sues drugmakers, PBMs over insulin pricing
(By: Ella Jeffries for Becker’s Hospital Review) The Missouri attorney general’s office has filed a lawsuit against 19 pharmacy benefit
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