Record settlement: BCBS agrees to pay $2.8 billion in antitrust case

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In the largest settlement of its kind in the health care industry, the Blue Cross Blue Shield Association and 33 independent BCBS companies have agreed to pay $2.8 billion to settle antitrust claims from providers.

The association also must make significant operational changes across 16 categories, including how it processes claims, communicates and contracts with and makes payments to providers. The tentative agreement still requires approval from U.S. District Judge R. David Proctor, and a special committee will monitor BCBS for five years following the court’s final settlement approval.

Despite the settlement, Blue Cross Blue Shield denies the allegations made in the lawsuit.

“This settlement ends a long-running legal challenge to the Blue Cross Blue Shield Association license agreements and related rules,” a spokesperson told Becker’s Payer Issues. “However, to reach a settlement and put years of litigation behind us, we have agreed to make certain operational changes and provide a monetary payment to the provider class involved in the case.”

Health systems, physicians and other providers initially filed the lawsuit in 2012, accusing BCBS companies of conspiring to divide markets to avoid competing with one another, which allegedly drove up costs and reduced reimbursements.

“Over the past 12 years, we have dedicated an extraordinary amount of time, tireless effort and resources to achieve this historic outcome for providers,” plaintiff attorney Edith Kallas said. “Many important issues for providers are finally being addressed. We’re pleased to have achieved relief that will create a better system for health care providers, supporting the organizations and individuals we rely on to take care of us and our families every day.”

This settlement follows another antitrust lawsuit from BCBS customers filed in 2012. In 2020, BCBS companies and the association reached a $2.7 billion settlement requiring BCBS companies to eliminate an association rule that mandated two-thirds of national net revenues from health plans and related services come from Blue-branded products. Another rule struck down by the settlement required large employers to work with the Blue insurer located where the employer was based, preventing BCBS companies from competing for large contracts.

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“Our members and health care provider partners can rest assured that Blue Cross and Blue Shield companies remain strong and ready to deliver exceptional services,” the spokesperson said. “We are committed to providing access to affordable, high-quality care and improving the health of the communities we serve, just as we have for 90 years.”