One of the largest reimbursement issues affecting 340B hospitals today remains largely invisible to the public.
Litigation involving provider claims for Medicare Advantage 340B underpayments has frequently been concluded in settlement before trial. While the public record provides some visibility into these disputes, the overall picture remains incomplete because arbitration proceedings—where many disputes are resolved—are generally confidential and unavailable for public review.
Several recent cases listed at the end of this article contain docket entries indicating that settlements were reached, or were pending final stipulation, or very similar outcomes.
Because most settlements and arbitrations remain confidential or sealed, hospitals and other 340B providers have limited access to information about how similar organizations have pursued and resolved underpayment claims. As a result, many providers may not fully appreciate the scale of recoveries that have occurred across the industry.
One notable exception is case 2:25-cv-142 (Forrest General Health Services, Inc. Et Al V. Healthspring Of Tennessee, Inc. Et Al) where court filings included the settlement documentation including the amount of a separate action, 25CV007370 (St. Joseph's/Candler Health System, Inc. v. Aetna Health, Inc.) Another matter, 2:24-cv-77 (The Health Care Authority For Baptist Health, An Affiliate Of UAB Health System V. Health Value Management, Inc. Et Al) appears to have been resolved through settlement based on publicly available reporting.
GDS has prepared hundreds of 340B MA damages analyses for arbitration and litigation matters involving Medicare Advantage reimbursement disputes. In many instances, cases have settled shortly before GDS expert testimony or formal damages arguments were due.
Multiple nationally recognized law firms continue to pursue these claims on behalf of providers, and the trend of pre-trial settlements appears to be continuing.
Despite the billions of dollars potentially at stake, Medicare Advantage 340B underpayments remain one of the least understood and least publicly discussed reimbursement issues facing American healthcare providers today.
2:24cv1691 Board Of Trustees Of The University Of Alabama For The University Of Alabama Hospital, The V. Unitedhealthcare Of Alabama Inc Et Al
5:24-cv-4067 Stormont-Vail Healthcare, Inc. V. Humana Inc. Et Al
5:24-cv-4047 Stormont-Vail Healthcare Inc. V. United Healthcare Services, Inc. Et Al
4:25-cv-104 University Health Systems Of Eastern Carolina, Inc. Et Al V. Aetna Health, Inc.
24CV001730-630 NASH HOSPITALS INC VS UNITEDHEALTHCARE OF NC
1:25-cv-172 Blue Ridge Healthcare Hospitals, Inc. V. Humana Insurance Company Et Al
5:25-cv-124 Catawba Valley Health System V. Health Value Management, Inc.
1:25-cv-462 University Of North Carolina Health Care System Et Al V. Humana Health Plan, Inc. Et Al