Blue Cross settles largest healthcare antitrust case in history for $2.8B
The largest healthcare antitrust settlement in history has just been reached and is pending approval from a federal judge.
Nonprofit medical insurance group Blue Cross Blue Shield (BCBS) has agreed to pay $2.8 billion to end an antitrust lawsuit brought by a group of hospitals, health systems and physicians who said the payer failed to properly reimburse them for care.
Further, the insurer is accused of making it difficult to renegotiate contracts. Some healthcare organizations were forced to drop out of their network due to alleged underpayment.
Attorneys representing the plaintiffs said the settlement will address many of these issues, as it contains concessions from BCBS that include changes to its operational procedures. These “new transformation parameters” will impact all 33 independent BCBS groups, which provide medical insurance nationwide on a regional basis.
“The $2.8 billion cash payment, together with the hundreds of millions of dollars in additional investments [BCBS is] making to improve their systems, will benefit providers enormously. We believe that the actual value to providers is much greater than the total payments,” Co-Lead Counsel for the plaintiffs, Joe Whatley, said in a statement from law firm WhatleyKallas.
BCBS has denied any wrongdoing and said in its own statement that it agreed to settle the case to “put years of litigation behind us.”
Health plans backed by new data platform
The lawsuits date to 2021 and include provider and healthcare groups from multiple states, carrying grievances that date back to health plans from 2008. Many of the complaints surrounded patients with BBCS BlueCard health plans, which will be seeing some changes as a result of the settlement.
Per the terms of the agreement, BCBS Blue will create a national data platform to better track claims and verify eligibility, to streamline reimbursement for patients and providers alike. The insurer will also be billed $700 million to cover legal costs for the plaintiffs.
BCBS has seen several lawsuits against it and its independent partners in recent years. The insurer settled a similar antitrust lawsuit in 2020 for $2.7 billion. Earlier this month, its Louisiana division paid out $421 million to a provider group to resolve claims it underpaid for breast reconstruction surgeries.
The settlement in this $2.8 billion antitrust case is expected to be approved by the U.S. district court in the coming months.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.