Luigi's Healthcare

The U.S. Food and Drug Administration said on Friday it would take action against telehealth provider Hims & Hers (HIMS.N), opens new tab for its $49 weight-loss pill, including restricting access to the drug's ingredients and referring the company to the Department of Justice for potential violations of federal law.

Luigi Mangione will not face the death penalty, federal judge rules

Luigi Mangione will not face the death penalty for allegedly killing UnitedHealthcare CEO Brian Thompson in December 2024, a federal district judge ruled Friday, dealing a blow to US prosecutors who were adamant about pursuing the ultimate sentence.

Epic sues health information network over nearly 300,000 illegally accessed records

Epic Systems, the company behind the largest electronic health records system in medicine, is suing health information network Health Gorilla and several of Health Gorilla’s clients over improperly accessing nearly 300,000 patient records managed by Epic. Epic’s lawsuit, filed Tuesday morning in a federal court in California, alleges fraud and breach of contract by Health Gorilla’s customers who requested and accessed the health records under the guise of being health care providers, and then using the records for financial gain instead of providing treatment.

Judge says she’ll hold a limited hearing on seizure of Luigi Mangione’s backpack

A U.S. federal judge on Monday said she will hold a short hearing in the next two weeks on procedures that police said allowed them to seize and look through Luigi Mangione’s backpack when he was arrested in the killing of UnitedHealthcare CEO Brian Thompson.

Johnson & Johnson owes $65.5 million to a woman with cancer who used talcum powder

A 37-year-old mother of 3 was awarded $65.5 million by a Minnesota jury which concluded that Johnson & Johnson's talcum products contributed to her cancer diagnosis

Luigi Mangione's pretrial hearing concludes as judge says he'll issue ruling on evidence in May

The evidence suppression hearing in the case against accused CEO killer Luigi Mangione concluded Thursday after the defense signaled it would call no witnesses. "The defense rests," defense attorney Karen Agnifilo said after prosecutors indicated they, too, rested. The nine-day hearing will determine what evidence will be used against Mangione when he goes on trial on charges of gunning down UnitedHealthcare CEO Brian Thompson on a Manhattan sidewalk last year.

Texas AG's lawsuit alleges Epic monopolizes EHR market, restricts parent access to children's data

Texas Attorney General Ken Paxton filed a lawsuit against Epic alleging the health tech company monopolizes the electronic health record market and cements its dominance in the market through an "anticompetitive playbook." The lawsuit, filed Wednesday, also accuses the company of engaging in deceptive practices that restrict parental access to their minor children’s medical records. The Texas AG is bringing the claims against Epic under the Texas Free Enterprise and Antitrust Act (TFEAA) and the Texas Deceptive Trade Practices Act.

Nearly $12.9M Anthem Settlement Ends Lawsuit Over Denial of Residential Treatment Coverage

A $12.875 million settlement has been reached to resolve a class action lawsuit that alleged that Anthem unlawfully denied coverage for residential treatment of mental health conditions or substance use disorders on the basis that the services were not medically necessary.

Bullets in Luigi Mangione’s bag convinced police that he was UnitedHealthcare CEO killing suspect

Moments after Luigi Mangione was handcuffed at a Pennsylvania McDonald’s, a police officer searching his backpack found a loaded gun magazine wrapped in a pair of underwear.

Anthem Healthcare Files Last-Ditch Legal Effort to Keep City Contract

The insurance giant is back in court in a fresh attempt to keep its lucrative business providing health insurance for New York’s civil servants before new coverage from UnitedHealthcare and EmblemHealth kicks in Jan. 1.

Ballad Health Sues UnitedHealth Group, Alleging Medicare Advantage Manipulation and Harm to Rural Patients

Health system says insurer overstated illness and denied needed care for patients and hospitals

Justice Dept officials' statements on Luigi Mangione broke court rules, judge says

Public statements by Justice Department officials about Luigi Mangione, the man charged with killing an insurance executive last year, violated a court rule meant to protect criminal defendants against publicity that could prejudice a jury pool against them, the judge overseeing the case said on Wednesday.

Eli Lilly's boss calls UK the 'worst' European country for drug prices

Eli Lilly (LLY.N) Chief Executive Dave Ricks said Britain was "probably the worst country in Europe" for drug prices in an interview with the Financial Times, intensifying pressure on the government to improve market conditions for drugmakers. The remarks are part of a broader backlash from pharmaceutical giants, including Merck (MRK.N) and AstraZeneca (AZN.L), who have paused or scaled back investments in Britain over the challenging environment.

Eli Lilly loses appeal of $183.7 million Medicaid fraud award

A federal appeals court on Thursday rejected Eli Lilly's (LLY.N), appeal of an $183.7 million judgment won by a whistleblowing lawyer and pharmacist who accused the drugmaker of defrauding Medicaid. The 7th U.S. Circuit Court of Appeals in Chicago said a federal jury reasonably found that Lilly knowingly concealed having retroactively increased prices on some drugs, and then failing to rebate Medicaid on the higher prices.

Judge denies UnitedHealth’s bid to limit discovery in AI coverage denial case

A federal judge in Minnesota has denied UnitedHealth Group’s request to narrow the scope of discovery in an ongoing lawsuit that accuses the insurer of using artificial intelligence to wrongfully deny Medicare Advantage members post-acute care.

Healthcare software giant Epic must face rival’s antitrust lawsuit, US judge rules

Healthcare software giant Epic Systems has lost a bid to dismiss part of a lawsuit alleging it unlawfully monopolized the market for U.S. medical records and caused health plans to pay higher costs. U.S. District Judge Naomi Reice Buchwald in Manhattan ruled on Friday that the plaintiff, healthcare data platform Particle Health, had presented enough information for now to pursue some claims that Epic violated antitrust law.

How athenahealth is approaching AI for physician practices as tech innovation accelerates

Athenahealth is rolling out new artificial intelligence features for ambulatory providers as part of a larger upgrade to an "AI-native" athenaOne platform. The aim is to provide a "reimagined user experience" for physician practices across key functions like interoperability, patient engagement, clinical documentation and revenue cycle management, the company said this week.

Investors Are Pressing UnitedHealth Group to Deny More Care

UnitedHealth Group’s investors have profited from its sky-high coverage denial rates. Now, as the company faces mounting public pressure to approve more patient care, they are suing to stop the insurer from changing its “corporate practices.”

Anthem Settles Mental Health Class Action Lawsuit

Anthem has settled a class action lawsuit brought by participants in employee health plans it administers, following negotiations and private mediation. The plan participants claim that Anthem violated the Employee Retirement Income Security Act (ERISA) and the Mental Health Parity and Addiction Equity Act (MHPAEA) by improperly denying coverage for inpatient mental health and substance use disorder treatment based on impermissibly restrictive eligibility criteria.

The United States filed a complaint today under the False Claims Act (FCA) against three of the nation’s largest health insurance companies — Aetna Inc. and affiliates, Elevance Health Inc. (formerly known as Anthem), and Humana Inc. — and three large insurance broker organizations — eHealth, Inc. and an affiliate, GoHealth, Inc., and SelectQuote Inc. The United States alleges that from 2016 through at least 2021, the defendant insurers paid hundreds of millions of dollars in illegal kickbacks to the defendant brokers in exchange for enrollments into the insurers’ Medicare Advantage plans.

When Emily Dwyer was 15 and in need of treatment for anorexia, her parents had to refinance the mortgage on their home to pay for it after United Healthcare denied coverage

The company’s lawyer explained that United’s denial came after three separate psychiatrists working on behalf of the insurer concluded that Dwyer was no longer engaging in concerning behaviors — not over-exercising and not struggling as much at meals. As a result, United’s doctors agreed that, after five months, she didn’t need the additional treatment at the facility that her own doctors said was essential.

UnitedHealth faces federal scrutiny into whistleblower claims

Attention comes in wake of ex-employees’ allegations that insurer paid nursing homes to reduce hospital transfers and used improper tactics to gain Medicare Advantage enrollees.

Anthem Blue Cross Fined $550,000 for Two-Month Delay in Approving Therapy After an Independent Medical Review Found the Service Was Medically Necessary

The Department of Managed Health Care (DMHC) is a California state agency charged with regulating insurance companies offering health plans in the state. When insurers violate laws intended to protect consumers and ensure access to adequate healthcare, the DMHC’s Office of Enforcement has many tools at its disposal to punish violators and order corrective actions. Administrative penalties are common and can easily range in the tens of thousands of dollars, although such a fine might be only a drop in the bucket against a billion-dollar company like Blue Shield of California, Health Net, Aetna, or the many other insurers operating in California.

Epic Systems sued by CureIS Healthcare for alleged ‘scheme to destroy’ its business

CureIS Healthcare filed a civil suit against Epic Systems, alleging the electronic health record company has carried out a “multi-prong scheme to destroy” CureIS’ business. The lawsuit represents another legal battle for Epic, which houses medical records for about 280 million patients in the U.S.

Oracle engineers caused dayslong software outage at U.S. hospitals

Oracle engineers triggered a five-day software outage at a number of Community Health Systems hospitals, causing the facilities to temporarily return to paper-based patient records.

US prosecutors to seek death penalty against Luigi Mangione in UnitedHealth executive's murder

U.S. prosecutors formally told a court on Thursday that they plan to seek the death penalty for Luigi Mangione, who is accused of murdering a UnitedHealth Group (UNH.N), executive in New York last year. Mangione, 26, is due to appear in Manhattan federal court for an arraignment on Friday. He has pleaded not guilty to a separate New York state indictment he faces over the murder of Brian Thompson, the CEO of UnitedHealth's insurance division.

UnitedHealth shares crash after surprise earnings miss, cuts to forecast

UnitedHealth Group (UNH.N), opens new tab surprised investors with what its CEO said was an "unusual and unacceptable" quarterly earnings miss, and it lowered its outlook for the full year due to higher-than-expected medical costs, sparking a more than 20% selloff in shares that reverberated across the sector.

DOJ to seek death penalty for Luigi Mangione in CEO Brian Thompson murder case

Attorney General Pam Bondi has ordered Department of Justice prosecutors to seek the death penalty in the case against Luigi Mangione in connection with the Dec. 4 slaying of UnitedHealthcare CEO Brian Thompson.

Judge advances case over Cigna use of algorithms to deny health claims

The judge allowed breach of fiduciary duties and unfair competition claims to go forward, given Cigna's own requirements to have a human doctor evaluate the need for care.

Oracle Health server breach leads to hospital extortions, reports say

Oracle Health reportedly suffered a data breach earlier this year in which hospitals’ patient data were stolen from the company’s legacy servers.

UnitedHealth Group resists shareholder proposal on delayed and denied care

UnitedHealth Group is attempting to swat down a non-binding shareholder proposal that asked the company to prepare reports on the costs of delayed and denied healthcare.

Judge Decides Class Action Can Proceed Against UnitedHealth for Use of AI

On February 13, 2025, a federal court issued a highly anticipated ruling in Estate of Gene B. Lokken v. UnitedHealth Group (CASE 0:23-cv-03514-JRT-SGE)—denying UnitedHealthcare’s attempt to dismiss certain state law claims and allowing breach of contract and good faith claims to move forward. It’s a major development in a case I first discussed back in November 2023, when UHG was sued over AI-driven coverage denials under its Medicare Advantage plans. Given this new ruling, it’s a perfect time to revisit the original lawsuit’s claims and the broader legal risks that AI poses in healthcare.

‘It’s a money game to them’: a son takes on UnitedHealth over his elderly father’s care

This article is more than 11 months old ‘It’s a money game to them’: a son takes on UnitedHealth over his elderly father’s care Robby Martin has joined a lawsuit against UnitedHealth after the insurance giant cut off his father’s nursing home coverage – five days later his father died at home

The gene therapy Zolgensma helped children born with a fatal disease, spinal muscular atrophy, grow up to run and play. But the cost was stunning: $2 million per dose. While taxpayers and small charities funded the drug’s early development, executives, venture-capital backers and a pharma giant have reaped the profits. The drug’s cost adds to the nation’s ballooning bill for prescription drugs and puts Zolgensma out of reach for kids in many low- and middle-income countries.

Luigi Mangione accepts $300K in donations for legal defense in murder case: lawyer

Luigi Mangione, the man accused of killing UnitedHealthcare CEO Brian Thompson in New York, has accepted almost $300,000 from people who claim to be his fans.

UnitedHealth Is Sick of Everyone Complaining About Its Claim Denials

Two months after UnitedHealthcare’s CEO was murdered, the insurer is moving to protect its image

Epic hits back at Particle Health counterargument as it pushes to get antitrust case dismissed

It continues to be a war of words—in the form of legal filings—between Epic and Particle Health as the startup fights to keep its antitrust lawsuit moving forward. Health tech company Particle filed an antitrust lawsuit against Epic in September in the Southern District of New York alleging that the electronic health record giant is trying to muscle out competition. Particle is a data platform that aggregates health information for digital health companies through APIs, providing access to more than 300 million patients’ medical records. With a 36% market share of the hospital sector, EHR giant Epic is a dominant force in the health IT industry.

New AI tool counters health insurance denials decided by automated algorithms

Class-action lawsuits allege algorithms turn down claims in seconds and critics say reform is needed for lasting change

Pfizer Agrees to Pay Nearly 60M to Resolve False Claims Allegations Relating to Improper Physician Payments by Subsidiary

Pharmaceutical company Pfizer Inc. (Pfizer), on behalf of its wholly-owned subsidiary Biohaven Pharmaceutical Holding Company Ltd. (Biohaven), has agreed to pay $59,746,277 to resolve allegations that, prior to Pfizer’s acquisition of the company, Biohaven knowingly caused the submission of false claims to Medicare and other federal health care programs by paying kickbacks to health care providers to induce prescriptions of Biohaven’s drug Nurtec ODT.

Shareholders urge UnitedHealth to analyze impact of healthcare denials

UnitedHealth Group (UNH.N), opens new tab shareholders on Wednesday said they requested the company prepare a report on the costs and public health impact related to its "practices that limit or delay access to healthcare."

Annual ‘winners’ for most egregious US healthcare profiteering announced

At No 2 was the behemoth that is UnitedHealth and how it’s become the fourth-largest business in the nation. Doctors for United have reported pressure to reduce time spent with patients, and make patients seem as sick as possible through aggressive medical coding tactics.

Drugmakers plan to raise U.S. prices on at least 250 branded medications including Pfizer (PFE.N), opens new tab COVID-19 treatment Paxlovid, Bristol Myers Squibb's (BMY.N), opens new tab cancer cell therapies and vaccines from France's Sanofi (SASY.PA), at the start of 2025, according to data analyzed by healthcare research firm 3 Axis Advisors

When Emily Dwyer was 15 and in need of treatment for anorexia, her parents had to refinance the mortgage on their home to pay for it after United Healthcare denied coverage

The company’s lawyer explained that United’s denial came after three separate psychiatrists working on behalf of the insurer concluded that Dwyer was no longer engaging in concerning behaviors — not over-exercising and not struggling as much at meals. As a result, United’s doctors agreed that, after five months, she didn’t need the additional treatment at the facility that her own doctors said was essential.

Defense fund established by supporters of suspected CEO killer Luigi Mangione tops $200K

As Luigi Mangione pleaded not guilty Monday to state murder and terrorism charges in the brazen killing of UnitedHealthcare CEO Brian Thompson, supporters of the suspect continued to donate tens of thousands of dollars for a defense fund established for him, leaving law enforcement officials worried Mangione is being turned into a martyr. Several online defense funds have been created for Mangione by anonymous people, including one on the crowdfunding website GiveSendGo that as of Tuesday morning had raised over $200,000.

Luigi Mangione pleads not guilty to murdering healthcare insurance CEO

The suspect accused of killing UnitedHealthCare CEO Brian Thompson has pleaded not guilty to murder and terrorism charges in New York state. Luigi Mangione, 26, appeared in court on Monday to be arraigned on 11 state criminal counts, including murder as an act of terrorism. As well as the state-level charges, he is also accused of federal (national-level) stalking and murder offences that could lead to a death penalty sentence.

Epic asks court to throw out Particle Health antitrust lawsuit

Epic Systems is asking a district court to throw out Particle Health's antitrust lawsuit, arguing that the startup failed to present the electronic health record company's anticompetitive conduct in its suit. Epic filed a motion to dismiss late Thursday evening, seeking to dismiss Particle Health's lawsuit through oral arguments.

Blue Cross and Blue Shield of Kansas City denied coverage of a medicine that a Missouri woman says could save her life, leaving her with a monthly bill of over $8,000. “I was at risk for spontaneous internal bleeding that could kill me,” Kaitlyn Sy said. Sy, a University of Kansas medical student, said she’s fighting back just weeks after a near-death experience. She’s been forced to pause her medical studies while waiting for this medicine to be approved, compromising her already weak immune system.

Luigi Mangione indicted on murder charges for shooting of UnitedHealthcare CEO Brian Thompson

A New York grand jury indicted Ivy League graduate Luigi Mangione for allegedly murdering UnitedHealthcare CEO Brian Thompson on Dec. 4.

Suspect in CEO's killing wasn't insured by UnitedHealthcare, company says

There is no record that Mangione, 26, was ever insured by the company, UnitedHealth Group said. Mangione has been charged with murder in New York in the fatal shooting of CEO Brian Thompson on a New York City street on the morning of Dec. 4, as Thompson was walking to a hotel where an investor conference was being held.

The gun CEO killing suspect Luigi Mangione had upon arrest matches shell casings from the crime scene, police say

The 3D-printed gun that health care CEO killing suspect Luigi Mangione had when he was arrested this week in Pennsylvania matches three shell casings found at the crime scene in Midtown Manhattan, the New York Police Department commissioner said Wednesday, as authorities continue to investigate the motive for the killing.

UnitedHealthcare CEO shooting suspect charged with murder

Luigi Mangione, the suspect in the killing of UnitedHealthcare CEO Brian Thompson, has been charged with murder in New York and is facing four other charges including one count of forging a document and criminally possessing a firearm, online court documents show.

UnitedHealthcare Has Faced Scrutiny Over Denying Claims

The company has been accused of using algorithms to deny treatments and refusing coverage of nursing care to stroke patients.

Words found on shell casings where UnitedHealthcare CEO was shot dead, senior law enforcement official says

Shell casings found at the scene where the UnitedHealthcare CEO was shot dead by a masked gunman in front of a busy New York City hotel had the words “deny,” “defend” and “depose” written on them, a senior New York City law enforcement official briefed on the investigation confirmed to NBC News on Thursday.

UnitedHealthcare CEO Brian Thompson fatally shot in targeted attack, gunman still at large

Brian Thompson, the CEO of UnitedHealth Group’s insurance unit, was fatally shot outside the Hilton hotel in midtown Manhattan on Wednesday morning, in what appears to be “a brazen, targeted attack,”

America’s largest insurers hire EviCore to make decisions on whether to pay for care for more than 100 million people. EviCore uses an algorithm that allows it to adjust the chances that company doctors will screen prior authorization requests, increasing the possibility of denials.

The biggest player is a company called EviCore by Evernorth, which is hired by major American insurance companies and provides coverage to 100 million consumers — about 1 in 3 insured people. It is owned by the insurance giant Cigna. A ProPublica and Capitol Forum investigation found that EviCore uses an algorithm backed by artificial intelligence, which some insiders call “the dial,” that it can adjust to lead to higher denials. Some contracts ensure the company makes more money the more it cuts health spending. And it issues medical guidelines that doctors have said delay and deny care for patients.

Senate report slams Medicare Advantage insurers for using predictive technology to deny claims

UnitedHealth, CVS and Humana used technology to increase MA prior authorization denials for post-acute services, boosting profits, according to a report for a Senate subcommittee.

Epic Systems v. Particle: What the Carequality investigation reveals about the dispute

Late Tuesday night, Carequality released new information about its investigation into the dispute between electronic health records vendor Epic Systems and health data startup Particle Health that has now escalated into an antitrust lawsuit. The dispute between the two started earlier in the year when Epic accused Particle of requesting and sharing health data with customers in violation of Carequality’s rules. Carequality, a nonprofit, runs an “interoperability framework,” an agreement that governs how health care providers share medical records with each other.

Healthcare software giant Epic hit with lawsuit over US patient records

Healthcare software giant Epic Systems was hit with a lawsuit on Monday by a startup accusing it of unlawfully controlling the market for U.S. medical records, harming patient care and causing health plans to pay higher costs.

Electronic health records giant Epic Systems sued over alleged monopolistic practices

The health data company Particle Health has filed an antitrust lawsuit against Epic Systems, alleging that the electronic health record vendor has used its control of patient data to thwart competition and undermine its business. The suit filed Monday in federal court in the Southern District of New York is a full-throated assault on Epic’s dominance in the market for electronic health records, charging that the privately held company has become a “behemoth” and a “monopolist in the EHR software market.”

Cigna says 4th lawsuit still shows no evidence of improper claim denials

Plaintiffs have had four chances to make a case that Cigna improperly rejected medical claims, the health insurer said in a new court filing. Cigna asked the District Court for the District of Eastern California to toss out a class-action lawsuit filed by the plaintiffs now numbering six.

Humana used algorithm to deny care to Medicare Advantage patients, lawsuit claims

Humana is the latest insurer to be sued over its use of artificial intelligence in claims processing, with a lawsuit alleging the payer used AI model nH Predict to improperly deny care to elderly Medicare Advantage patients. In a class action lawsuit filed Tuesday, plaintiffs argued the payer prematurely cut payments for MA beneficiaries’ rehabilitation care. According to the suit, Humana based the cuts on the AI model’s “rigid and unrealistic predictions for recovery” — not doctors’ recommendations — despite knowing the model’s estimations were often “highly inaccurate.”

Lawsuit claims UnitedHealth AI wrongfully denies elderly extended care

UnitedHealth Group Inc (UNH.N), opens new tab uses an artificial intelligence algorithm that systematically denies elderly patients' claims for extended care such as nursing facility stays, according to a proposed class action lawsuit, opens new tab filed on Tuesday.

Pfizer to pay $50 mln to settle drug wholesalers' EpiPen antitrust claims

Pfizer (PFE.N) has agreed to pay $50 million to settle claims by drug wholesalers that they overpaid for EpiPen allergy treatment devices as a result of anticompetitive tactics by the drugmaker. In a filing Tuesday in Kansas City, Kansas, federal court, the wholesalers said the settlement was fair and would avoid the risk that the 10th U.S. Circuit Court of Appeals would uphold an order by U.S. District Judge Daniel Crabtree dismissing their claims. The class action settlement must still be approved by the judge.

Cigna hit in August with another lawsuit over claims denials through PxDx

The class-action suit was filed in late August in Connecticut federal court and alleges Cigna is using the tool to batch-deny claims knowing its members likely won't fight the decision. "PxDx allows Cigna medical directors to automatically deny a claim purportedly on medical grounds without making a medically necessary determination or even opening the patient file, leaving patients with unexpected bills that should have been covered and paid," the plaintiff said in the suit. "Indeed, Cigna automatically denies claims because it knows that most patients will either pay such bills or forego the procedures, rather than deal with the hassle of appealing a denial."

UnitedHealth sued by US Labor Department over 'thousands' of claims denials

The U.S. Department of Labor is alleging UnitedHealth Group denied thousands of patients' payments for emergency room services and urinary drug screenings. The lawsuit states that UMR, a third-party administrator and UnitedHealth subsidiary, denied claims based on diagnosis codes and failed to abide by requirements of the Affordable Care Act (ACA) and Labor Department’s claims procedures regulation.

Cigna Health Insurer Accused of Denying Claims in Bulk in New Lawsuit

A new lawsuit accuses health insurance company Cigna of denying claims in bulk, causing patients to pay for medically necessary procedures, tests, exams, and other services that their insurer should have otherwise covered.

Cigna health giant accused of improperly rejecting thousands of patient claims using an algorithm

A federal lawsuit alleges that health insurance giant Cigna used a computer algorithm to automatically reject hundreds of thousands of patient claims without examining them individually as required by California law.

Cigna violated the law by denying claims for imaging and other services in bulk, lawsuit alleges

Cigna violated the law by denying claims for imaging and other healthcare services in bulk, a class action lawsuit filed on Monday alleges. The Bloomfield, Connecticut-headquartered health insurer utilizes an algorithm called PXDX, purportedly enabling its staff medical doctors to automatically reject payment requests in “batches of hundreds of thousands at a time” based on pre-set criteria. This, the complaint alleges, allowed Cigna to evade California’s legally required individual physician review process.

Pharmaceutical company AbbVie Inc. has agreed to pay $2.7 million to settle a whistleblower False Claims Act lawsuit, which alleged that the company used unlawful kickbacks to encourage medical providers to prescribe its drug Humira. The settlement comes seven years after whistleblower who worked as a “nurse ambassador” for an AbbVie subcontractor accused the company of using nurse ambassadors to perform administrative tasks that would typically be done by Humira prescribers themselves. As part of the settlement, Suarez will receive $756,000 as a whistleblower reward.

Drugmakers including Pfizer Inc (PFE.N), opens new tab, GlaxoSmithKline PLC (GSK.L), opens new tab, Bristol Myers Squibb (BMY.N), opens new tab, AstraZeneca PLC (AZN.L), opens new tab and Sanofi SA (SASY.PA), plan to raise prices in the United States on more than 350 unique drugs in early January, according to data analyzed by healthcare research firm 3 Axis Advisors. The increases are expected to come as the pharmaceutical industry prepares for the Biden Administration's Inflation Reduction Act (IRA), which allows the government's Medicare health program to negotiate prices directly for some drugs starting in 2026. The industry is also contending with inflation and supply chain constraints that have led to higher manufacturing costs.

Attorney General James Provides $13.6 Million to Consumers Who Were Denied Mental Health Care Coverage By United Healthcare

New York Attorney General Letitia James today announced the completion of $13.6 million in payments to consumers who were denied health care coverage under her landmark agreement with UnitedHealthcare, the nation’s largest health insurer. The payments are a result of an agreement that Attorney General James reached in August 2021 that resolves her federal lawsuit against United for illegally denying coverage of outpatient psychotherapy for thousands of members. This month, the settlement administrator concluded payments totaling $13.6 million for patients across the country, with almost $8 million to more than 20,000 New Yorkers with behavioral health conditions who received denials or reductions in reimbursement. In connection with the 2021 agreement, United also paid $725,000 directly to consumers who had been impacted by United’s illegal practices.

Pfizer accused of Covid profiteering as first-quarter sales hit $26bn

Pfizer has made nearly $26bn (£21bn) in revenues in the first three months of the year, the bulk from its Covid-19 vaccine and new pill to treat the virus, prompting fresh accusations of pandemic profiteering.

Aetna hit with class-action lawsuit alleging discriminatory policies for mental health treatment

Insurance giant Aetna has been hit with a class-action lawsuit over mental health parity as the demand for behavioral health services ramps up during the COVID-19 pandemic. The complaint, which was filed this week in U.S. District Court in the Central District of California, alleges that Aetna illegally denied claims for mental health residential treatment services.

Pfizer Agrees to Pay $345M to Settle EpiPen Price Hike Case

Pfizer Inc. and two of its subsidiaries have agreed to pay $345 million to settle lawsuits related to allegations of anticompetitive pricing and marketing of EpiPen auto-injectors.

Electronic Health Records Technology Vendor to Pay $18.25 Million to Resolve Kickback Allegations

A national electronic health records (EHR) technology vendor based in Watertown, Massachusetts, athenahealth Inc. (Athena), has agreed to pay $18.25 million to resolve allegations that it violated the False Claims Act by paying unlawful kickbacks to generate sales of its EHR product, athenaClinicals, the Justice Department announced today.

Lawsuit accuses Aetna of systematically denying coverage for cancer treatment

The lawsuit, which has been moved to the District Court for the Middle District of Florida, was filed by Scott Lake. Mr. Lake claims Aetna wrongfully denied coverage for proton beam radiation therapy to treat his prostate cancer. The denial, which deemed the treatment experimental, came despite recommendations from oncologists, he claims.

Drugmakers including Pfizer Inc , GlaxoSmithKline PLC and Sanofi SA are planning to hike U.S. list prices on more than 200 drugs in the United States on Wednesday, according to drugmakers and data analyzed by healthcare research firm 3 Axis Advisors. Nearly all of the price increases will be below 10%, and around half of them are in the range of 4 to 6%, said 3 Axis co-founder Eric Pachman. The median price increase is around 5%, he said.

Aetna settles suit alleging claim-denying medical director never read patient’s records

Aetna has settled a lawsuit in which a company medical director said under oath that he never looked at patients’ records when deciding whether to approve or deny coverage – testimony that prompted an investigation by the California insurance commissioner.

Aetna ordered to pay $25.5 million for denying coverage to woman who died of cancer

An Oklahoma jury has awarded $25.5 million to the family of a cancer patient denied coverage by Aetna, with jurors saying that the insurer acted “recklessly” and that the verdict was meant as a message for Aetna to change its ways. The award is believed to be the largest verdict in an individual “bad faith” insurance case in Oklahoma history, one court observer said, and could have major ramifications across the country for a form of cancer treatment called proton beam therapy.

California’s Regulators To Investigate Aetna’s Medical Coverage Decisions

Both of California’s health insurance regulators said they will investigate how Aetna Inc. makes coverage decisions, as the lawsuit of a California man who is suing the nation’s third-largest insurer for improper denial of care heads for opening arguments on Wednesday.