The Ambetter lawsuit landscape centers on a single accusation repeated across federal court, state court, and regulatory dockets: that Centene Corporation’s Ambetter marketplace plans are sold using provider directories that overstate who is actually available to treat patients. As of 2025, a federal racketeering class action is moving forward in Illinois, a Texas class action has been revived by the Fifth Circuit, a California case settled for $40 million, and an Arizona wrongful death suit is pending over a customer who died after failing to find a therapist through the plan.
The Core Allegation: Ghost Networks
Plaintiffs and regulators use the term “ghost networks” to describe what they say is the underlying problem with Ambetter. Provider directories list doctors, therapists, and hospitals as in-network when those providers are retired, deceased, not accepting new patients, or not actually contracted with the plan. Consumers pick a plan based on the directory, then find they cannot get care or receive bills for treatment they believed was covered.
The San Diego City Attorney’s Office alleged that directories for Centene subsidiary Health Net had an overall error rate above 18 percent, climbing to 35 percent for psychiatrists. In Illinois, a Centene subsidiary acknowledged in writing that it had failed to follow state statutes on directory updates.
The Federal RICO Class Action: Havrilla v. Centene
The broadest pending case is Havrilla v. Centene Corp., filed August 5, 2022, in the U.S. District Court for the Northern District of Illinois. It names Centene Corporation, Centene Management Company, and Celtic Insurance Company, and seeks class status for Ambetter purchasers in 26 states, a group the complaint says could exceed 10 million people.1Scribd. Class Action Lawsuit
The complaint invokes the Racketeer Influenced and Corrupt Organizations Act, alleging a multi-billion-dollar scheme to defraud consumers and the federal government through mail and wire fraud. It says Centene published false provider directories, sold plans with few or no participating doctors, and collected premiums for coverage that did not meet ACA requirements. The suit also brings claims under the Illinois Consumer Fraud and Deceptive Business Practices Act and consumer protection statutes in 10 other states.2Chicago Tribune. Illinois Consumers Sue Health Insurer Centene
Centene moved to dismiss, calling the case an “attack on the Health Insurance Marketplace and the ACA itself.” On May 2, 2024, Judge Nancy L. Maldonado denied most of that motion. The court found the plaintiffs had pleaded enough facts to allege a RICO conspiracy involving mail and wire fraud and described the allegations as resembling a “prototypical RICO case.” Only two claims were dismissed: unjust enrichment and a claim under Nebraska’s consumer protection statute. The plaintiffs are proceeding on the federal RICO claim and claims under 11 state consumer protection laws, and are seeking class certification.3Wexler Boley & Elgersma LLP. Plaintiffs Largely Defeat MTD RICO Lawsuit Centene
The Texas Class Action Revived: Wilson v. Centene
Wilson v. Centene Management Company sought certification of a class of everyone who bought Ambetter from Superior HealthPlan policies between January 2014 and December 2021. The district court denied class certification, ruling that the named plaintiffs lacked standing because their expert testimony on inflated-premium damages was insufficient.
On July 17, 2025, the U.S. Court of Appeals for the Fifth Circuit vacated that ruling and sent the case back. The appellate court held that the trial judge had blended the standing inquiry with merits-based scrutiny of the damages evidence and applied the wrong legal standard for standing at the class certification stage. The Fifth Circuit found the plaintiffs had “sufficiently established individual and class standing,” while leaving the Rule 23 class certification requirements for the district court to evaluate on remand.4Circuit Split. Wilson v. Centene Mgmt
The $40 Million San Diego Settlement
The San Diego City Attorney’s Office sued Health Net LLC in 2021 under California’s Unfair Competition Law and False Advertising Law, with the California Attorney General’s Office serving as co-counsel. The case settled on October 13, 2025, for $40 million.
Of that, $12 million goes toward enforcement of California consumer protection laws, and roughly $28.5 million is earmarked for compliance programs to improve directory accuracy. Health Net must provide weekly updates to its online directories and quarterly updates to printed ones, hire a consultant to oversee the improvements, and set up a 24-hour consumer assistance phone line.5City of San Diego. Health Net Settlement Announcement6Times of San Diego. Health Net Pay $40M Settle San Diego Lawsuit Over Misleading Directories
The Coutinho Wrongful Death Case
The most severe individual case involves Ravi Coutinho, an Arizona man who bought an Ambetter plan in 2023. A lawsuit filed by his mother, Barbara Webber, says Coutinho made 21 documented calls to Ambetter in early 2023 trying to find a therapist, spending more than five hours on the phone. Representatives could not provide accurate referrals or identify therapists actually contracted with the plan. He also could not find a primary care doctor willing to refill his antidepressant prescriptions. He died in May 2023 from complications of excessive alcohol use.7ProPublica. Centene Ghost Network Lawsuit Ambetter Ravi Coutinho
Webber filed the wrongful death suit on May 23, 2025, in Maricopa County Superior Court, naming Centene Corporation and Health Net of Arizona. The complaint alleges negligence and consumer fraud and says the defendants knowingly maintained inaccurate directories despite a prior Arizona regulatory investigation that found Health Net’s directories were “riddled with inaccuracies.” It cites violations of the ACA, the Mental Health Parity and Addiction Equality Act, the No Surprises Act, and Arizona state law.8Healthcare Dive. Centene Ghost Network Coutinho Death Lawsuit As of mid-2025, Centene had not publicly responded. Webber’s attorney has said the case is intended to go before a jury.9Latin Times. Arizona Man Died After Months of Failed Attempts to Access Mental Health Care
Earlier Cases and State Regulatory Actions
The current litigation follows years of regulatory findings. One of the earliest cases, Harvey v. Centene Corp., was filed January 11, 2018, in the Eastern District of Washington. Lead plaintiff Cynthia Harvey of Spokane was billed $1,544 for an emergency room visit after finding Centene had no in-network ER physicians in her area. Co-plaintiff Steven A. Milman of Texas paid over $1,200 per month for a plan only to discover his clinic was not in-network and that he had been assigned an OB/GYN as his primary care physician.10Terrell Marshall Law Group. Centene Corporation Healthcare Fraud Class Action The case was later settled and formally terminated in September 2020.11CourtListener. Harvey v. Centene Corporation
State insurance regulators have brought their own actions covering the same conduct:
- Washington’s Insurance Commissioner fined Centene subsidiary Coordinated Care $1.5 million in December 2017 after more than 100 complaints about missing doctors and surprise out-of-network bills. The company admitted failing to monitor its network and acknowledged shortages of anesthesiologists, immunologists, dermatologists, and rheumatologists. Under the consent order, $500,000 was due immediately and $1 million was suspended contingent on two years without further violations.12CNBC. Centene Fined $1.5 Million, Can Resume Obamacare Sales in Washington13Affordable Care Act Litigation. Coordinated Care Final Consent Order No. 17-0477
- The Arizona Department of Insurance and Financial Institutions investigated Health Net of Arizona in 2021 and found the insurer failed to maintain accurate provider directories.14ProPublica. Ambetter Ghost Network Consequences
- Illinois fined a Centene subsidiary more than $1 million in 2022 for mental health-related violations, including maintaining an inaccurate directory.14ProPublica. Ambetter Ghost Network Consequences
- Georgia’s Office of Insurance and Safety Fire Commissioner confirmed in 2023 that it had received a formal complaint along with “similar complaints against this insurer” and was investigating.15Atlanta News First. Ambetter Health Accused of Defrauding Georgia, US Families
The Missouri Rebates Are Something Different
A separate money story involving Ambetter is worth flagging so it isn’t confused with the fraud litigation. In Missouri, Ambetter from Home State Health spent only 71.4 percent of its roughly $1 billion in 2024 premiums on medical care, below the ACA’s 80 percent Medical Loss Ratio floor for individual market insurers. That triggered $87.5 million in rebates to Missouri policyholders, with notification letters dated September 10, 2025. The rebate calculation by the Centers for Medicare and Medicaid Services uses a three-year rolling period covering 2022 through 2024.16Missouri Independent. Federal Rules Force $1B in Customer Rebates for Missouri’s Biggest Health Insurer MLR rebates are a standard ACA compliance mechanism, not a penalty for fraud, though the size of the Missouri payout is unusual: over 12 years of the ACA, Missouri policyholders have received $587.1 million in rebates from all insurers combined, meaning the Ambetter rebate alone is roughly 15 percent of that total.
Which Company Is Actually Being Sued
Ambetter is a marketplace brand, not a single insurance company. Centene Corporation delivers Ambetter plans through state-level subsidiaries, and different lawsuits name different ones depending on where the plaintiff bought coverage: Coordinated Care in Washington, Health Net of Arizona, Superior HealthPlan in Texas, Celtic Insurance Company as an underwriter in several states, and Ambetter of Peach State in Georgia, among others.17Ambetter Health. About Us – Centene Centene Management Company, LLC is a separate corporate entity named as a defendant in several suits for its alleged role in the operational decisions behind the provider directories. Ambetter plans are sold exclusively through the ACA Health Insurance Marketplace, and the customer base skews toward individuals and families who do not get insurance through an employer and often qualify for federal premium subsidies.18Healthcare Dive. Lawsuit Accuses Centene of Misleading Customers on Narrow ACA Plans If you’re weighing whether a case applies to your situation, check which subsidiary issued your plan.