Blue Cross and Blue Shield (BCBS) has agreed to a $2.8 bn settlement as part of a long-standing antitrust class action filed by health care providers.
The settlement, which totals $2.8 bn in cash, is the largest antitrust settlement ever reached in the U.S. health care sector.
In addition to this payment, BCBS has agreed to invest hundreds of millions more in changes that aim to reduce the administrative burdens and inefficiencies faced by providers.
The lawsuit alleged that BCBS used exclusive service areas to limit competition among its entities, resulting in price fixing and below-market reimbursements for providers. While BCBS denies these claims, the company agreed to the settlement to end years of litigation and make operational changes.
The case against Blue Cross and Blue Shield (BCBS) emerged from allegations of anticompetitive practices that spanned several years. It all started in 2012, when a retired chiropractor filed the first lawsuit, claiming that BCBS entities were engaging in practices that stifled competition.
The lawsuits were consolidated as multiple similar cases cropped up across the United States, including in states like Florida, North Carolina, and Montana.
At the heart of the case was the allegation that BCBS had divided the U.S. into exclusive service areas, which were designed to prevent competition between various BCBS organizations.
By carving up territories, BCBS entities allegedly fixed prices, limiting the reimbursement rates offered to health care providers and creating an unfair market environment. Providers claimed that this behavior led to below-market payments for their services and reduced competition overall.
These operational improvements include reforms in 16 key areas, such as speeding up payments, improving transparency in decision-making processes, and providing more timely updates on claim statuses.
by 
