BCBS reaches $2.8 billion settlement agreement
The payment is the largest in a healthcare antitrust case, providers say, and settles 12 years of litigation.
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Blue Cross Blue Shield has reached a tentative agreement to pay $2.8 billion to settle an antitrust lawsuit with providers, according to records filed in federal court in Alabama on Monday.
Blue Cross Blue Shield has agreed to pay $2.8 billion to settle claims from hospitals, physician groups and other providers that actions taken by BCBS insurers shortchanged them on reimbursements.
Providers allege BCBS violated antitrust laws by entering into noncompete agreements with other BCBS members in selling health insurance and in the administration of commercial benefits in the United States and Puerto Rico.
The settlement stems from a 2012 complaint that claimed Blue Cross Blue Shield members agreed to divide up markets among themselves and allegedly fixed the prices paid to providers through the organization's BlueCard Program.
BCBS has denied allegations of wrongdoing.
The agreement is subject to approval from U.S. District Court. The payment is the largest in a healthcare antitrust case, providers said in court records.
In addition to provider payment, the estimated 6 million class members who filed claims may also benefit. The deadline to file a claim was Nov. 5, 2021, according to BCBS.
Also, according to the providers' law firm, Whatley Kallas, the settlement will affect how BCBS processes claims and communicates with and makes payments to providers. The firm further expects that the settlement will help alleviate and address resource-draining administrative burdens and inefficiencies experienced by providers, according to the American Hospital Association.
WHY THIS MATTERS
The court did not decide who is right or wrong. Instead, the plaintiffs and defendants have agreed to a settlement to avoid the risk and cost of further litigation, BCBS said.
BCBS asserts that its conduct resulted in lower healthcare costs and greater access to care for its customers.
THE LARGER TREND
Health providers first sued in 2012.
The court granted final approval to the settlement on Aug. 9, 2022, but there was a lengthy appeals process that went to the Supreme Court, upholding the settlement agreement.
Email the writer: SMorse@himss.org
