Legal and regulatory issues
Kickback allegations: The U.S. Department of Justice filed a False Claims Act complaint alleging Elevance, along with Aetna and Humana, paid hundreds of millions of dollars in illegal kickbacks to insurance brokers for steerage into their Medicare Advantage plans, notes the Department of Justice and Healthcare Finance News.
Medicare star ratings: A federal judge ruled against Elevance in its lawsuit challenging the government's calculation of its Medicare star ratings, reports Reuters and STAT News.
Behavioral health claims: The company is facing a class-action lawsuit and reached a preliminary settlement of $12.9 million for allegedly improperly denying coverage for residential treatment for mental health and substance use disorders, according to Becker's Payer Issues.
"Ghost network" lawsuit: Elevance is involved in a second lawsuit accusing it of maintaining "ghost networks," which are inaccurate provider directories, causing members to be misled about in-network providers, notes Modern Healthcare News.
Securities investigation: The company is also under investigation for potential securities law violations, as reported by GuruFocus.