Health News

April 6, 2026

Payers have faced state penalties in 2026 for slow reimbursements, mishandled member complaints, and mental health parity violations. Fines in 2025 are here.

Payers fined by states in 2026:

1. Cigna was fined $80,000 by Maryland in March after regulators determined a newly enacted automatic downcoding policy was not allowed under state law.
2. Aetna was fined $550,000 by Pennsylvania in March following a market conduct exam that found violations in mental health parity laws.
3. EmblemHealth was fined $2.5 million in February after an investigation by the New York attorney general’s office found the insurer violated parity laws and failed to ensure access to mental healthcare services because of inaccurate provider directory listings.
4. Centene’s Health Net was fined $1.3 million by California in February “for mishandling payment disputes from doctors, hospitals and other providers.”
5. Anthem Blue Cross was fined $15 million by California in January due to “longstanding and widespread failures” with handling member complaints
6. 11 insurers were fined nearly $25 million by Georgia in January for violating state mental health parity laws, including Oscar, Anthem, Kaiser, Cigna, Aetna, Humana, UnitedHealthcare, CareSource, and Alliant Health Plans.
7. Kaiser Foundation Health Plan was fined $300,000 by Washington state in January for failing to comply with federal mental health parity requirements, though $100,000 of that amount was suspended.

At the Becker’s 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration.

Judge rules Aetna, Elevance, Humana must face Medicare kickback allegations

A judge denied a motion to dismiss a lawsuit alleging a broker kickback scheme involving CVS Health’s Aetna, Elevance Health and Humana, according to a March 25 filing in the U.S. District Court in Massachusetts.

The judge also ruled that Medicare Advantage brokers GoHealth, SelectQuote and eHealth will continue to face litigation. In 2025, the government decided to intervene and the Department of Justice filed the sweeping lawsuit, building on a 2021 whistleblower complaint. The lawsuit alleged that, between 2016 and 2021, insurers agreed to pay brokers “hundreds of millions” in exchange for marketing services that steered beneficiaries away from competitor plans.

The lawsuit also said Humana and Aetna arranged payments to be hinged on limiting the number of beneficiaries enrolled with disabilities. This may have interfered with how brokers treated those with disabilities who were seeking Medicare coverage.

The latest filing allows the government to move forward with the kickback and discrimination concerns, but the judge dismissed the unjust enrichment claim. The court said there is a sufficient legal alternative, the False Claims Act, to recover money.

In a statement shared with Becker’s, eHealth said it “is disappointed” with the decision and denies the allegations.

“As we have consistently stated since first disclosing this matter, eHealth has cooperated fully with the Department of Justice and remains confident that we have operated in compliance with applicable regulations,” the brokerage said. “We intend to vigorously defend ourselves as the case moves forward. eHealth remains committed to providing unbiased, expert guidance to consumers navigating the complexities of health insurance.”

MA marketing practices have been subject to scrutiny in recent months. In July, HHS said it kicked off a study into “misleading” efforts. In August, a SelectQuote shareholder filed a proposed class action against the broker and its leaders, alleging the company misled investors amid the DOJ investigation.

CVS and Aetna declined to comment. Becker’s also contacted Elevance, Humana, GoHealth and SelectQuote and will update this story if more information becomes available.

At the Becker’s 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration.