The Elevance Health lawsuit drawing the most attention is a securities fraud class action filed in May 2025, which accuses the insurer and its top executives of misleading investors about the financial damage caused by post-pandemic Medicaid redeterminations. It is not the company’s only active legal problem. Elevance, which also operates under the Anthem Blue Cross brand, is simultaneously facing federal sanctions over Medicare data submissions, a $15 million California fine over member complaint handling, a failed challenge to Medicare star ratings, contract fights in New York and Georgia, and noncompete and discrimination suits filed by and against former employees.
The Securities Fraud Class Action
Miller v. Elevance Health, Inc. was filed on May 12, 2025, in the U.S. District Court for the Southern District of Indiana.{1Stanford Law School Securities Class Action Clearinghouse. Elevance Health, Inc. Securities Litigation} The proposed class covers shareholders who bought Elevance stock between April 18, 2024, and October 16, 2024.{2BLB&G. Miller v. Elevance Health, Inc.}
Named defendants include the company itself, CEO Gail K. Boudreaux, CFO Mark B. Kaye, EVP Felicia F. Norwood (who oversaw government health benefits), and former VP of Investor Relations Stephen V. Tanal.{3BLB&G. Elevance Initial Complaint} An amended complaint filed in October 2025 added Peter Haytaian, EVP and President of the Carelon division.{4BLB&G. Amended Complaint, Elevance}
The complaint centers on the Medicaid redetermination process, in which states resumed checking eligibility after years of pandemic-era continuous enrollment. Plaintiffs allege Elevance executives told investors they were closely tracking cost trends and that premium rates negotiated with states were sufficient for the risk profile of remaining members. According to the complaint, that was misleading. Redeterminations were disproportionately removing healthier, lower-cost members, leaving Elevance with a sicker and more expensive population that the company’s financial guidance did not reflect.{2BLB&G. Miller v. Elevance Health, Inc.}
The amended complaint alleges Elevance internally knew Medicaid costs were running three to five times higher than historical averages while executives’ public statements kept the stock price elevated and their stock-linked compensation intact.{4BLB&G. Amended Complaint, Elevance}
The Stock Drops Behind the Case
Two disclosures anchor the fraud theory. On July 17, 2024, after Elevance flagged rising Medicaid utilization, shares fell $32.21, roughly 5.8%.{2BLB&G. Miller v. Elevance Health, Inc.} The bigger break came on October 17, 2024, when third-quarter results badly missed Wall Street estimates. Adjusted earnings came in at $8.37 per share against a $9.66 estimate, and Elevance cut full-year adjusted EPS guidance from $37.20 to $33.00.{5Forbes. What’s Behind the 15% Fall for Elevance Health Stock} Shares dropped more than 13% in early trading.{6Investopedia. Elevance Health Stock Plunges on Profit Hit From Fall in Medicaid Memberships}
Boudreaux attributed the miss to “unprecedented challenges in the Medicaid business” and a “timing mismatch between Medicaid rates and the higher acuity of our members.”{} The benefit expense ratio climbed 270 basis points to 89.5%.{7Elevance Health. Q3 2024 Quarterly Earnings}
Where the Case Stands
A group of Dutch institutional investors led by Stichting juridisch eigenaar Achmea IM Liquid Asset Funds was appointed lead plaintiff in August 2025. An amended complaint was filed in October 2025, and a motion for leave to file a corrected version followed on October 31, 2025. As of the most recent docket update in late May 2026, the court had not ruled on that motion, and the case is ongoing before Judge James Russell Sweeney II.{8CourtListener. Miller v. Elevance Health, Inc.}{1Stanford Law School Securities Class Action Clearinghouse. Elevance Health, Inc. Securities Litigation}
Federal Sanctions Over Medicare Data
In February 2026, the Centers for Medicare & Medicaid Services imposed intermediate sanctions on Elevance for what it called “substantial and persistent noncompliance” with Medicare Advantage risk adjustment data submission rules. The sanctions covered 45 Medicare Advantage contracts and included a suspension on new enrollment and a halt on marketing.{9CMS. Elevance Health Sanction Notice}
The underlying problem was mundane. Since at least November 2018, Elevance had been submitting corrections for potentially unverified diagnosis codes on encrypted USB flash drives instead of through the required electronic systems. CMS sent six instructional letters between 2019 and 2025, and the practice continued as recently as October 2025. The agency found this caused failures to report and return overpayments within the required 60-day window.{9CMS. Elevance Health Sanction Notice}
CMS initially set sanctions to take effect March 31, 2026, then extended the deadline to May 30 and later to July 1, 2026, while Elevance worked on corrections. Several plans were exempted.{10Elevance Health. Elevance Health Receives Interim Response From CMS}{} By mid-2026, the company had resubmitted the data and wired what it called its “best estimate of overpayments,” pegging total liability at roughly $935 million within a range of $350 million to $1.5 billion.{11Healthcare Dive. Elevance Again Avoids Medicare Advantage Sanctions}
The $15 Million California Fine
On January 30, 2026, the California Department of Managed Health Care fined Anthem Blue Cross $15 million for “longstanding and widespread” failures in identifying, processing, and resolving member grievances.{12California DMHC. Press Release, January 30, 2026} Regulators said the insurer failed to categorize nearly half of oral expressions of dissatisfaction as grievances in the cases reviewed and failed to adequately resolve 65% of so-called exempt grievances.
The DMHC said Anthem Blue Cross had repeatedly failed to fix its grievance system for more than 15 years, despite prior enforcement actions. As part of the penalty, Anthem agreed to work with an independent auditor for up to four years, with reports going directly to the state.{12California DMHC. Press Release, January 30, 2026} It was the largest in a string of California penalties. In 2024 and 2025, the DMHC imposed more than a dozen additional fines on Blue Cross of California entities, ranging from $80,000 to $5 million each.{13Good Jobs First Violation Tracker. Elevance Health}
Losing the Medicare Star Ratings Fight
Elevance sued CMS over the methodology used to calculate its Medicare Advantage star ratings, which drive substantial bonus payments. U.S. District Judge Mark Pittman of the Northern District of Texas ruled against the company on August 18, 2025.{14Healthcare Dive. Elevance Loses Medicare Advantage Star Ratings Lawsuit}
The fight was over rounding. Elevance argued that a composite score of 3.749565 should round up to 4, qualifying it for a higher tier. Pittman disagreed, writing that “3.749565 is closer to 3.5 than to 4” and calling the company’s methodology “essentially gerrymandered to give it the result it wants.” He held CMS had acted within its statutory authority.{14Healthcare Dive. Elevance Loses Medicare Advantage Star Ratings Lawsuit} The loss was expected to cost Elevance at least $375 million in bonus payments and rebates across five disputed contracts for 2025.
The No Surprises Act Suit Against HaloMD
Anthem Blue Cross, through its California subsidiaries, sued HaloMD and affiliated providers, alleging they exploited the No Surprises Act’s independent dispute resolution process to extract inflated payments for out-of-network services. Anthem claimed HaloMD submitted more than 1,500 arbitration proceedings between January 2024 and August 2025, roughly 47% of them allegedly ineligible, and accused the company of violating federal anti-racketeering and ERISA laws.{15Becker’s Payer Issues. California Judge Dismisses Elevance’s No Surprises Act Lawsuit Against HaloMD}
On April 9, 2026, Judge Karen Scott of the Central District of California dismissed the case, ruling that judicial review of the arbitration process is “narrowly constrained” and that the suit failed to establish a basis for invalidating the arbitration results.{16STAT. Halo MD No Surprises Act Lawsuit Blue Cross California} Elevance filed a notice of appeal on April 13, 2026.{17Georgetown Law Litigation Tracker. Anthem Blue Cross v. HaloMD LLC}
Contract Disputes in New York and Georgia
Elevance is fighting to hold onto a contract covering roughly 750,000 New York City civil servants and their dependents after the city awarded new business to UnitedHealthcare and EmblemHealth. Anthem filed two suits in New York County Supreme Court calling the selection process “arbitrary and capricious.” A Manhattan judge dismissed the first, and Anthem appealed. A second suit, filed in November 2025, adds claims about the city’s move to a self-funded plan structure. Much of the litigation is under seal.{18The City. Anthem UnitedHealth EmblemHealth Lawsuit Health Insurance}
In Georgia, Amerigroup, an Elevance subsidiary and one of the state’s largest Medicaid managed care providers, lost its bid when Georgia awarded new Medicaid contracts to CareSource, Molina Health Care, UnitedHealthcare, and Humana. Amerigroup and Peach State Health Plan filed protests alleging the process was tainted by conflicts of interest, including a claim that CareSource hired a Department of Community Health official who had helped draft the bid documents.{19The Current GA. Contract Disputes Create Uncertainty Over Georgia’s Medicaid Oversight} The Georgia Department of Administrative Services denied the protests in November 2025 and held additional hearings in December, without a final decision by late 2025.{20Georgia Recorder. Fight Over Georgia’s Medicaid Contracts Nears the End} The contract start date has been pushed to at least early 2027.{}
Noncompete and Employment Suits
In January 2026, Elevance sued four former senior leaders of its Puerto Rico operations in the Southern District of Indiana: Dr. Waldemar C. Ríos Alvarez, Dr. Benjamin Guardiola, Jaime Rivera Pesante, and Dr. Sara Ramos Gonzalez. They resigned between August and September 2025 and took similar roles at Triple-S Salud, described as the largest health insurer in Puerto Rico and a direct competitor.{21The Indiana Lawyer. Elevance Health Seeks More Than $1M in Breach of Contract Lawsuit Against Former Executives} Elevance alleges violations of noncompete and non-solicitation clauses and seeks the return of roughly $1.1 million in equity awards.{22Becker’s Payer Issues. Elevance Sues 4 Former Execs Over Noncompete Violations}
On the other side of the employment ledger, former employees have sued the company for disability discrimination. In March 2026, Priscilla Kamoi, a registered nurse who worked at Elevance for 17 years, filed suit in Los Angeles County Superior Court. Kamoi, who has severe trigeminal neuralgia, alleges her physician’s May 2024 request for breaks and additional time during pain episodes was denied within two weeks, and that a supervisor told her to “get another job.” She claims the company then imposed strict hourly productivity quotas, disciplined her for missing them, and terminated her in May 2025.{23PRWeb. Helmer Friedman LLP Files Suit Alleging Elevance Fired Veteran Nurse}
Across all these fronts, tracking data shows Elevance and its subsidiaries have accumulated 594 recorded enforcement actions since 2000, totaling more than $1.06 billion, the majority tied to consumer protection and insurance violations.{13Good Jobs First Violation Tracker. Elevance Health}