Bloomberg said the pharmacy benefit manager is being probed as part of a larger look into the “prescription management services” of UnitedHealth. According to sources, this may be related to an ongoing investigation into alleged instances of Medicare Advantage upcoding.

A merger between Eversana and Waltz Health will create a new entity that CEO Mark Thierer says will upend the “existing oligopoly that I helped build.”

The two said they’ve been negotiating terms for eight months. Sticking points include denied claims and coverage disputes, with both the insurer and health system pointing fingers.

The settlement reached in October 2024 has been finalized. A fund is being set up for the estimated 3 million claimants, as BCBS pledges to reform its BlueCard health plans.

The initial incident happened in April. Since that time, the notorious cybercrime cell Interlock has claimed responsibility. A data dump from the breach was put up for sale on the dark web.

The insurance giant is charging the new board committee with monitoring company policies related to prior authorizations, claims adjudication and AI. The group is scheduled to meet four times a year.

Two lots of IV solution bags from the company were found to contain particulate matter that could cause blockages in blood vessels, killing a patient. To date, no serious adverse events have been reported.

That number includes $285 million in damages. CVS Health’s PBM was found to have committed fraud when it pressured insurers to overbill Medicare Advantage plans for patient care services.