Skip to Main Content
Wexler Boley & Elgersma LLP
  • Our Firm
    • Who We Serve
      • Shareholders
      • Whistleblowers
      • Consumers
      • Businesses
      • Government Entities
    • Our Professionals
    • Working with Wexler Boley & Elgersma LLP
    • Locations
    • News
    • Careers
    • Report Your Concern
    • Testimonials
  • Practice Areas
    • Antitrust Litigation
    • Business & Commercial Litigation
    • Securities & Corporate Governance
    • Healthcare Litigation
    • Consumer Protection
    • Whistle Blower False Claims Litigation
    • Government Representation
    • Employment Litigation
  • Cases
    • Antitrust Litigation Cases
    • Business & Commercial Litigation Cases
    • Consumer Protection Cases
    • Employment Litigation Cases
    • Government Representation Cases
    • Healthcare Litigation Cases
    • Mass Tort Litigation Cases
    • Securities & Corporate Governance Cases
    • Whistle Blower False Claims Cases
  • Investigations
    • Rental Rate Antitrust Lawsuit
    • Automobile 3G Network Shutdown Lawsuit
    • Similac Toxic Infant Formula Lawsuit
    • Kid’s Castle Biometric Privacy Lawsuit
    • Contaminated Baby Food Lawsuit
    • Fatal Sportmix Pet Food Recall Class Action Lawsuit
    • Claire’s Data Breach Lawsuit
    • Insurance Denial for Mental Health and Substance Abuse Treatment
    • Perpetual Sales Litigation
    • Railroad Price-Fixing Lawsuit
    • Medicare Advantage Fraud Litigation
    • Biometric Fingerprinting Litigation
  • Blog
  • Contact Us
See all news
8.8.2022

New RICO Suit Filed by Wexler Boley & Elgersma LLP Accuses Centene Corporation, One of the Largest Health Insurers in the U.S., of Defrauding Millions of Consumers

Centene Corporation and affiliate companies allegedly engaged in a multi-billion dollar scheme to defraud consumers in violation of the Racketeer Influenced and Corrupt Organizations Act (“RICO”)

Centene Corporation—currently the largest provider of health-insurance plans sold on the online exchanges established by the Affordable Care Act (ACA)—and its affiliates have been allegedly selling fraudulent health-insurance policies to millions of predominantly low-income consumers under the “Ambetter” brand name, according to a RICO lawsuit filed on Friday in the United States District Court for the Northern District of Illinois, Havrilla, et al. v. Centene Corp., et al., Case No. 1:22-cv-04126.

Centene and its affiliate companies market their signature Ambetter policies across 26 states. According to the suit, those consumers have been allegedly overcharged by hundreds of millions of dollars each year because the plans don’t deliver the benefits promised to consumers and fail to satisfy the minimum requirements imposed by the Affordable Care Act. Specifically, the suit alleges that Centene and its affiliates have misrepresented the benefits of Ambetter plans by, among other things, providing lists of in‑network providers that defendants know to be false. When the consumers who purchase the plans attempt to find a medical provider, the suit alleges, they quickly learn that very few—sometimes none—of the providers on the Ambetter in‑network list actually accept Ambetter insurance.

The class action lawsuit may affect over 10 million customers who have purchased Ambetter plans. In addition to consumers, the lawsuit highlights the overcharges Ambetter has inflicted on taxpayers and government entities. Ambetter Silver‑tier plans sold by Centene qualify for cost‑sharing through federal subsidies, meaning that the government pays for part of the monthly premiums and the insured individual receives lower out-of-pocket costs. Approximately 90% of the Ambetter plans sold through the exchanges are Silver‑tier plans, and the lawsuit alleges that, by knowingly selling the misrepresented Ambetter plans, Centene and its affiliates have defrauded the federal government of hundreds of millions of dollars every year.

“The worst part of this alleged Ambetter scheme is that it intentionally targets and manipulates the most vulnerable people amongst us,” said Justin Boley, Partner at Wexler Boley & Elgersma LLP. “These are victims that need care and are working with government-subsidized programs designed to ensure they receive at least a bare minimum of coverage. That’s not what they’re getting.”

The lawsuit alleges that Centene and its affiliate companies have used mailings and wire communications to carry out their alleged scheme by sending Ambetter plan documents and invoices to current or potential plan members, electronically filing Ambetter plan documents with the online health insurance exchanges of 26 states, and receiving fraudulently procured premium payments electronically from plan members. According to the complaint, these actions constitute millions of violations of the mail-and wire-fraud statutes by Centene and its affiliates, constituting a pattern of racketeering activity under federal RICO laws.

Plaintiffs seek to recover the overcharges that persons who purchased Ambetter plans incurred as a result of the defendants’ deceptive practices, as well as an injunction ordering Centene and its affiliate companies to stop the alleged unlawful conduct.

About Wexler Boley & Elgersma LLP
Wexler Boley & Elgersma is a high-stakes litigation law firm with a commitment to excellence and the achievement of meaningful relief for those we serve. Based in Chicago, WBE has extensive experience in antitrust, business & commercial, and complex class action litigation in both state and federal court. More information is available at http://www.wbe-llp.com or 312-346-2222.

Share

  • Facebook
  • Twitter
  • LinkedIn
Image

311 S. Wacker Drive,
Suite 5450
Chicago, IL 60606
P_312.346.2222
F_312.346.0022

  • Our Firm
  • Practice Areas
  • Cases
  • Investigations
  • Newsroom
  • Blog
  • Contact Us
  • Sitemap
  • Privacy Statement
  • Legal Disclaimer

2023 © Wexler Boley & Elgersma LLP

Wexler Boley & Elgersma uses cookies to improve the performance and functionality of this site. By using our website, you are providing us with your consent to use cookies on this site. Close Privacy Policy
Privacy & Cookies Policy

Privacy Overview

This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may affect your browsing experience.
Necessary
Always Enabled
Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.
Functional
Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features.
Performance
Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors.
Analytics
Analytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc.
Advertisement
Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. These cookies track visitors across websites and collect information to provide customized ads.
Others
Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet.
SAVE & ACCEPT