Aetna Sued Over Prepaid Cards, UHC Docs Questioned, The Villages Health Is For Sale

Hey all,

Happy Thursday! UnitedHealthcare continues to face a relentless wave of federal investigations, with each new probe into its Medicare Advantage billing practices and business conduct intensifying scrutiny on the industry giant. Meanwhile, CVS Aetna and other major insurers are entangled in high-profile lawsuits from plans and providers, raising the question: how long before we witness the first RICO trial targeting a health insurance plan? Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(BenefitsPRO) Aetna, CVS Health Hit with Class-Action Lawsuit over Prepaid Debit Cards

A new class-action lawsuit accuses Aetna and its parent company CVS Health of forcing healthcare providers to accept reimbursement via prepaid debit cards that incur merchant fees of 3.5%–4.5%, while allegedly denying requests for alternative payment methods. The lawsuit, filed by West Loop Chiropractic & Sports Injury Center, claims this practice unfairly shifts Aetna’s administrative costs onto providers, highlighting ongoing scrutiny over the insurer’s payment practices and following a string of legal challenges including a 2024 antitrust suit. In response, Aetna reportedly offered to settle—just as soon as providers submitted their appeals via carrier pigeon or Morse code. Full Article

(HEALTH CARE un-covered) and DOJ Questions UnitedHealth Doctors

Medicare Advantage Upcoding: Federal prosecutors are investigating UnitedHealth over allegations it manipulated diagnosis codes in Medicare Advantage to secure inflated payments from taxpayers. This DOJ probe, involving interviews with ex-employees about pressure tactics, software tools, and financial incentives tied to “upcoding,” reflects mounting concern over widespread abuse in a program now covering more than half of all Medicare enrollees. Now that CMS and the DOJ are both digging in, UnitedHealth might need to try something unfamiliar: a growth strategy that isn’t wildly sketchy. Full Article

(Fierce Healthcare) Humana’s CenterWell to Acquire The Villages Health in ‘Stalking Horse’ Deal

Humana’s CenterWell has agreed to acquire The Villages Health (TVH), a Florida-based senior care provider serving over 55,000 patients, in a “stalking horse” bid following TVH’s bankruptcy filing. The deal is intended to stabilize operations and maintain care for Medicare patients, even as TVH addresses a $361 million Medicare billing discrepancy under federal investigation. And given The Villages’ reputation for wild nights, stiff drinks, and a social scene that rivals spring break, it’s no surprise the community’s healthcare system needed some extra help recovering from all those hangovers. Full Article.