Commercial health plans have made numerous policy changes in response to the COVID-1 pandemic, some of which were done in response to mandates issued by state and federal governments, and others in response to pressures being...more
The Federal Trade Commission has issued orders to five health insurers and two health systems requiring them to provide information that will assist the FTC in studying the competitive effects of certificates of public...more
On Monday, September 17, 2018, the Antitrust Division of the United States Department of Justice (the “DOJ”) cleared Cigna’s proposed $67 billion acquisition of Express Scripts, the country’s largest pharmacy benefit manager....more
The FBI and OCC have each launched inquiries into pricing practices within American Express’s forex unit with an aim to determine “whether the foreign-exchange international payments department misrepresented pricing to...more
On July 9, 2018, President Trump announced his intention to nominate D.C. Circuit Court Judge Brett Kavanaugh to replace retiring Justice Anthony Kennedy on the Supreme Court....more
Historically, health plans and pharmacy benefit managers (“PBMs”) have been uncomfortable neighbors. Plans provide drug coverage, but contract out the provision of such drugs to independent PBMs. PBMs in turn earn market...more
As reported in earlier blogs, the federal Department of Justice (DOJ) has been actively looking into potential abuses by Medicare Advantage (MA) Organizations as to allegedly improper risk adjustment claims submissions and...more
The Antitrust Division recently issued its 2017 annual spring update. The update emphasizes the Division’s recent litigation victories, particularly in the merger context. In his introductory remarks, Assistant Attorney...more
WHO IS AT RISK - The federal government has indicated that it is still investigating, and could ultimately join a false claims whistleblower qui tam action against Aetna, Inc., Humana, Inc., Cigna, Inc. (through its Bravo...more
In July 2016, following a lengthy review, the Antitrust Division of the Department of Justice (DOJ), together with several states, sued to block two proposed health insurer mergers: Aetna/Humana and Anthem/Cigna. On January...more
Securing the Safety Net for America's Vulnerable Populations - Editor's Note: America's population is aging rapidly. By 2029, 75 million baby boomers will have reached age 65 and older, and older adults will represent...more
On February 8, 2017, the United States District Court for the District of Columbia granted a request filed by the U.S. Department of Justice’s Antitrust Division for an injunction blocking Anthem, Inc.’s (Anthem) proposed $54...more
In the past month, the DOJ and several state governments scored two trial wins in their challenges to mergers among some of the country’s largest health insurers. First, Judge Bates of the District of Columbia blocked the...more
In a continuation of recent Department of Justice (DOJ) successes challenging mergers, the U.S. District Court for the District of Columbia recently enjoined two more proposed mergers brought and litigated under the Obama...more
While the election of Donald Trump as the nation's next president is clearly the biggest news in Washington over the last two months, for the insurance industry, big news has also been made at the federal district courthouse....more
The trial over Aetna and Humana's $37 billion proposed merger kicked off today in a Washington, D.C. federal court. At issue is whether the companies' merger would substantially lessen competition in the market for...more
In late July, the DOJ Antitrust Division filed actions in federal district court seeking to derail both the Anthem/Cigna and Aetna/Humana mergers. In each case, the DOJ contended that consumers would face higher insurance...more
The waiver of copayments, coinsurance, and deductibles owed by patients treated by out-of-network laboratories and other providers is a hot topic in the health care industry. Despite the near absence of clear legal...more
Fast Facts - - In the first three quarters of 2016, there were 24 significant merger investigations, which is on pace to challenge the record of 37 set in CY2015. - Significant merger investigations through Q3 2016...more
Following more than a year of regulatory review, in late July 2016 the Department of Justice (DOJ) Antitrust Division and a number of states filed actions seeking to derail both the Anthem/Cigna and Aetna/Humana mergers. In...more
In July 2015, health insurer mergers were announced between Anthem and Cigna and between Aetna and Humana. The effect of these mergers would elevate Anthem/Cigna to the #1 rank in size among national health insurers. ...more
Last week, the United States Department of Justice’s Antitrust Section (DOJ) filed suit to enjoin two proposed mergers that would consolidate the nation’s five largest insurance companies into three. The DOJ argues that if...more
Consolidation in health insurance markets can injure hospitals and doctors by creating buyer-side market power that can force providers to accept below-market prices, limit patients’ access to care, and reduce innovation in...more
The U.S. Department of Justice (DOJ), joined by attorneys general from several states, filed a lawsuit last Thursday in the U.S. District Court for the District of Columbia seeking to block two major mergers between health...more
The Department of Justice and attorneys general from multiple states last week sued to halt two health insurance mergers, each worth billions of dollars. The challenged deals are Anthem’s planned merger with Cigna and...more