PHYSICIANS WIN SETTLEMENT AGAINST BLUE CROSS AND BLUE SHIELD OF FLORIDA


On April 27, the Blue Cross and Blue Shield Association and 23 of its affiliated companies, including Blue Cross and Blue Shield of Florida, filed a settlement in the Federal District Court in Miami. This settlement upon approval will establish 128 million dollar fund which doctors may seek compensation or donate money to a charity. The Blue plans also agreed to pay physicians’ legal fees, up to $49 million.

The settlement also calls for enhancements in business practices including the way BCBSF processes and pays claims. A number of improvements called for in the settlement are already in place at BCBSF or are underway as part of their focus on continuous improvement.

The settlement is the third legal settlement between physician groups and large health insurers. In 2003, Aetna U.S. Healthcare agreed to pay $170 million and Cigna Healthcare agreed to pay $540 million to correct a pattern of unfair business practices. United Health Care is the last health insurer who has not settled in this case.

The class action - Love et al. v. Blue Cross and Blue Shield Association, et al. - was filed in 2003, and has been pending before U.S. District Judge Federico Moreno in federal court for the Southern District of Florida in Miami. The complaint identified numerous Blue Cross and Blue Shield plans as defendants in an alleged scheme to defraud doctors in violation of the federal Racketeer Influenced and Corrupt Organizations Act (RICO).

To view a copy of the agreement CLICK HERE.