In a major blow to health insurer Blue Cross Blue Shield, a federal judge ruled Wednesday that non-hospital healthcare providers can proceed to trial with claims the insurance giant schemed for years with its affiliates to illegally underpay providers by billions of dollars.
U.S. District Judge R. David Proctor denied Blue Cross’ bid for summary judgment in the long-running case, finding the providers “presented evidence of actual injury as a result of the alleged conspiracies.”
The decision clears the path for a jury trial on antitrust damages claims by doctors, clinics and other non-hospital providers in Alabama estimated at over $5 billion.
“We look forward to presenting all the issues for all healthcare providers to a jury,” said attorney Joseph Whatley Jr, who represents the plaintiffs.
The ruling comes after Judge Proctor previously allowed similar claims by more than 100 Alabama hospitals to move forward. It marks the latest major defeat for Blue Cross in the multidistrict litigation alleging the insurer schemed with its affiliates to limit competition and reimbursements.
A $2.7 billion settlement by Blue Cross with a class of insurance subscribers won approval last year in the 11th Circuit. But the healthcare providers have held out, alleging Blue Cross used improper coercion and collusion to suppress provider payments across its national network.
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According to the providers, Blue Cross leveraged its market dominance to impose unfavorable contract terms and illegally inflated premiums paid by individuals and employers. The result was insurance profits increased at the expense of fair reimbursements to providers.
Blue Cross argued the non-hospital providers failed to show concrete harm from any alleged antitrust activity. But Judge Proctor found sufficient evidence of damages for a jury trial on the issues. The court has not yet set a trial date.
The long-running case was centralized in Alabama federal court a decade ago. Blue Cross affiliate Anthem Inc is also named in the litigation. The insurer said it does not comment on pending cases.