BCBS' interlocutory appeal of antitrust lawsuit rejected

A judge denied Blue Cross Blue Shield plans' interlocutory appeal of an opinion and order ruling that how they do business may be an automatic violation of federal antitrust regulations.

Here are four things to know:

1. On Dec. 12, Judge David Proctor of the U.S. Court of Appeals for the 11th Circuit denied BCBS' petition for permission to appeal the district court's previous memorandum opinion and order.

2. In an April 5 ruling, Judge Proctor said provider- and member-sponsored litigation claiming the Blue Cross Blue Shield Association and its 36 members worked together under competitive restrictions, when considered altogether, may be a "per se" violation of the Sherman Act. The Sherman Act is the federal law banning unlawful trade restraints.

3. Specifically, the litigation argues BCBS insurers unlawfully conspire to divide markets and avoid competition with one another. As a result, consumers face higher prices and providers are paid less, the litigation alleges.

4. Of the Dec. 12, decision, Scott Nehs, senior vice president, general counsel and corporate secretary at Blue Cross Blue Shield Association, told Becker's Hospital Review: "The decision not to accept our appeal at this time was not unexpected, as pre-trial appeals are rare. This is another step in a very long process and we look forward to continuing to defend our case in the U.S. District court. We remain confident that we will ultimately prevail."

Editor's note: This article was updated to correct information about the judge's decision. 

More articles on payer issues:
CMS' final rule on risk adjustment payments: 3 things to know
BCBS of Wyoming customers overcharged due to banking error
ACA plan enrollment falls 11%: 3 things to know

© Copyright ASC COMMUNICATIONS 2019. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.


Top 40 Articles from the Past 6 Months