ELEVANCE HEALTH INC

Elevance Health (formerly Anthem) operates one of the largest U.S. health insurance platforms, covering approximately 46 million members. Federal and state regulators have documented a pattern of predatory insurance practices spanning claim denials, data fraud, enrollment manipulation, and provider network misrepresentation.

In February 2026, CMS imposed intermediate sanctions suspending Medicare beneficiary enrollment into Elevance's MA-PD plans, citing seven years of knowing noncompliance — the insurer submitted risk adjustment data via flash drives despite repeated CMS directives to use electronic systems. The sanction affects plans covering 1.9 million members. Separately, the Manhattan U.S. Attorney filed a civil fraud suit in March 2020 alleging Anthem used vendor Medi-Connect to run "one-sided" retrospective chart reviews that added diagnosis codes inflating Medicare payments but deliberately refused to delete invalid codes that would reduce revenue. The court estimated overpayments exceeded $100 million per year from 2014 to 2018; triple damages are sought and the case remains in discovery. In 2025, DOJ filed a second False Claims Act complaint naming Elevance alongside Aetna and Humana for hundreds of millions in illegal kickbacks to insurance brokers for Medicare Advantage enrollments between 2016 and 2021, coupled with allegations of discrimination against disabled Americans.

At the state level, California's DMHC fined Anthem $15 million in January 2026 for longstanding grievance and appeals failures, $8.5 million for mishandling 98,955 payment disputes, and $750,000 for sending 5,200 denial letters with incorrect appeal instructions. A federal court approved a $12.88 million class settlement for systematically denying mental health and substance use disorder claims using overly restrictive medical necessity guidelines (2017-2025). Three separate class actions allege Elevance maintains "ghost networks" — provider directories listing physicians who are not actually available — leaving members, including families of disabled children, unable to access care. In August 2025, a Texas federal judge rejected Elevance's lawsuit to inflate its Medicare Advantage star ratings, costing the company at least $375 million in bonus payments. Multiple health systems have sued for unpaid claims, including Bon Secours ($93 million) and Valley Health ($11.4 million).