Blue Cross antitrust legal issues persist as settlement denials seek damages
More than 30 people who withdrew from Blue Cross Blue Shield’s $ 2.67 billion antitrust settlement sued the National Health Plan Association on Monday, alleging that monopoly insurers’ activities were pushing up healthcare costs while by reducing the quality of care.
The lawsuit, filed in U.S. District Court for the Southern District of Florida, comes on behalf of 32 people living in five states and the District of Columbia who were at one point insured under one of the 18 Blues plans. issued by their employers. These plaintiffs have chosen not to participate in the preliminary settlement approved by Federal Judge David Proctor of the Northeast District of Alabama last year.
The pre-agreement aims to resolve a major lawsuit first filed in 2012 by customers who accused the Blues companies of limiting competition and product development, and of violating the Sherman Antitrust Act, a federal law of 1890 which prohibits monopolies and restriction of trade. By pulling out, claimants who were individually insured oppose the deal and demand separate – and presumably larger – payments. The Blue Cross and Blue Shield companies provide health coverage to more than 100 million people, or one in three U.S. residents.
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“Anti-competitive insurers’ agreements, the conduct of enforcement and foreclosure of competition have prevented consumers from being offered competitive premium prices,” the lawsuit said. The companies also “prevented consumers from being offered health insurance policies that offered better service and coverage that would result from competition in the market.”
The plaintiffs are asking the court for an injunction that would prevent subsidiaries of Blue Cross and Blue Shield from restricting competition between Blues operators, limiting how companies can use their Blues brand and ending a practice requiring that A specific portion of the company’s revenue comes from Blue Cross and Blue Shield Policies. Clients also seek treble damages, reasonable attorney fees and any other legal or equitable remedies deemed just and appropriate, as well as a jury trial.
As part of the preliminary antitrust settlement, the Blue Cross and Blue Shield Association repealed a rule that limited the amount of income its 35 member plans could generate from businesses unrelated to the Blues.
The Blue Cross and Blue Shield association declined to comment on the lawsuit. “Blue Cross Blue Shield’s plans remain focused on the goal that we have had for over 90 years: to improve access to quality health care for all Americans and the health of our local communities,” wrote a spokesperson in an email.
There may be other lawsuits brought by customers of Blue Cross and Blue Shield who have opted out of the antitrust settlement.
A group of large, self-funded domestic customers also submitted an informal request on Monday to withdraw from the preliminary deal approved by the Alabama federal court. The request is sealed. But a separate brief filed in Alabama federal court the same day says the group of plaintiffs believe the deal unfairly treats self-funded unions, churches, Taft-Hartley trusts, employer welfare plans, associative health plans and retirees compared to what some large national employers should receive.
Under the settlement agreement, national accounts must show that 70% of their plan members resided outside the state where the companies are headquartered, a requirement to which less than a third of all accounts nationals are satisfied. “The parties got their hands caught in the cookie jar,” the file says.
These self-funded clients are also asking the court to release all documents related to the settlement clause that promises lawyers for antitrust plaintiffs $ 667.5 million out of the $ 2.67 billion settlement.
A separate health care provider lawsuit is still pending in Alabama federal court. Doctors allege that the anti-competitive practices of the Blues have lowered the remuneration rates of doctors. Proctor is expected to make a final ruling on the matter this fall.