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The health insurance group may pay $2.7 billion to resolve allegations that the chain blocked competition.

The nation’s Blue Cross plans have reached a tentative $2.7 billion settlement in a federal lawsuit filed by their customers that accuses the group of engaging in a conspiracy to thwart competition among the individual companies, according to two people with knowledge of the discussions.

The settlement, which was first reported by The Wall Street Journal, would need to be agreed to by each of the three dozen Blue Cross insurers that make up the trade group, the...

Risk adjustment transfers totaled $10.8 billion in 2019, with some insurers on the ACA's exchanges earning substantial payouts, according to new data from the Trump administration.

The Centers for Medicare & Medicaid Services released (PDF) its annual look at the Affordable Care Act's risk adjustment program, and said that 561 insurers participated in 2019. The $10.8 billion was split evenly between payments made to insurers and payments to CMS to maintain budget neutrality.

The individual market accounted for the largest share of transfers, or about $7.98 billi...

Blue Cross Blue Shield insurers in six states have sued CVS Health Corp. over an alleged scheme to overcharge them for generic drugs by submitting claims for payment at “inflated prices.”

The lawsuit, filed May 27 in the Rhode Island federal court, added to mounting pressure that CVS has been facing since 2015 over its cash discount programs, which it said were designed to compete with Walmart and other “big-box” discounted pharmacies.

According to the complaint, health insurers typically negotiate “lesser-of” contracts with pharmacy benefits middlemen to pay the low...

A court ordered Blue Cross Blue Shield of Texas to pay more than $108 million in damages and attorney fees to two closed rural Texas hospitals.

Court filings in the U.S. Bankruptcy Court for the Western District of Texas showed that BCBSTX was ordered to make the payments to Little River Healthcare, which had hospitals in Rockdale and Cameron, Texas. The hospitals went into bankruptcy in 2018.

Former Texas Supreme Court Justice Harriet O'Neill, an independent arbitrator, awarded the amount to the hospitals during arbitration proceedings. Little River had argued BCBST...

Following a ruling in the U.S. Supreme Court, North Carolina's largest insurer says it will receive hundreds of millions of dollars to recover losses it incurred through the Affordable Care Act – money that could help offset huge expenses the company estimates it will face due to the coronavirus pandemic.

via bizjournals

The Department of Justice sued Anthem Blue Cross Blue Shield on Thursday for Medicare fraud after Anthem submitted inaccurate medical codes to receive higher Medicare reimbursement.

The lawsuit alleges that Anthem violated the False Claims Act when it deliberately ignored and submitted coding mistakes from 2014 to 2018. Federal prosecutors claim these coding errors yielded Anthem billions of taxpayer dollars.

The complaint highlights examples of fraud, including an instance from 2015 where Anthem coded a patient member as having active lung cancer. Despite this codin...

A group of Blue Cross Blue Shield plans in New York has sued Walgreens, alleging that the retail pharmacy giant has been overcharging for prescription drugs for more than a decade, according to Crain's Chicago Business.

The lawsuit accuses Walgreens of submitting prescription drug claims to BCBS at artificially inflated prices since 2007. 

BCBS alleges that Walgreens inflated the prices by billing for inflated "usual and customary prices," or the cost the general public would pay for prescriptions without going through insurance, instead of using a lower rate that ma...

One of California’s largest health insurance plans has distinguished itself, and not in a good way.

The state Department of Managed Health Care hit Anthem Blue Cross with $9.6 million in fines from January 2014 through early November 2019, according to a California Healthline analysis of agency data. That is about 44% of the $21.7 million in penalties the department issued against full-service health plans during that period.

And yet, Anthem covered only 10% to 13% of Californians with department-regulated plans. An annual average of 3.8 million Californians wer...

Anthem Blue Cross filed a lawsuit against the federal government to recoup $100 million in payments under the ACA, according to Bloomberg Law.

In the Nov. 18 lawsuit filed in the U.S. Court of Federal Claims, Anthem argued it sold plans on the ACA individual exchange because the government said it would offset expected losses on the policies through the risk corridors program. 

Risk corridors payments, which expired in 2016, aimed to protect insurers from large deficits as they enrolled sicker members into their new individual exchange policies. While the program int...

When a patient sees a provider, the patient signs an “assignment of benefits” contract with the provider, assigning the patient’s legal rights to recover benefits from the insurance company to the provider so that the provider can be directly reimbursed for the services rendered to the patient. When the provider is in-network, this process is executed with little fanfare. However, for an out-of network provider, the road to reimbursement is not always as smooth. Not all states expressly permit assignment-of-benefits clauses, and as a result, insurers send the reimb...

Emergency Department physicians being out of network is nothing new, but a new round of failed negotiations between a local emergency physician group and Blue Cross Blue Shield of Texas have both sides crying foul and pointing fingers.

Blue Cross Blue Shield contacted members to describe how Texas Medicine Resources, a physician group hired by Texas Health Resources emergency rooms, has terminated its deal with BCBSTX, meaning the group is now out of network at 14 area hospitals for its Blue Choice PPO and Blue Essentials HMO members.

A statement on BCBSTX’s “St...

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