Blue Cross Blue Shield Agrees to Pay $2.8 Billion to Settle Antitrust Claims

Blue Cross Blue Shield (BCBS) has reached a $2.8 billion settlement to resolve longstanding antitrust claims brought by hospital systems, physicians, and other healthcare providers. The plaintiffs, who filed the lawsuit in an Alabama federal court, alleged that BCBS underpaid them for reimbursements, per court documents filed on Monday.

This settlement marks the largest of its kind in a healthcare antitrust case, according to Reuters. The legal dispute stems from claims that BCBS and its affiliates engaged in anti-competitive behavior by dividing the U.S. into exclusive service areas, thereby inflating the cost of insurance and reducing provider reimbursements. This lawsuit, which was first brought forward in 2012, argued that the nationwide agreement among BCBS affiliates stifled competition, leading to higher costs for insurance consumers and financial losses for healthcare providers.

While Blue Cross Blue Shield denied the allegations, it agreed to the settlement in order to move past years of litigation. In a statement, BCBS said the agreement, which also includes operational changes, is intended to “put years of litigation behind us.” The company will now implement significant modifications to its BlueCard program, which enables providers to submit claims, a change that the plaintiffs’ lead attorneys, Joe Whatley and Edith Kallas, believe will transform the system. The proposed reforms are designed to bring greater transparency and efficiency to the claims process.

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The settlement, which is subject to approval by U.S. District Judge R. David Proctor, also requires BCBS to introduce a system-wide information platform that will facilitate member benefits, eligibility verification, and claims tracking. The plaintiffs’ attorneys believe these changes will enhance accountability and create more contracting opportunities for healthcare providers.

In addition to the $2.8 billion financial settlement, Blue Cross will reportedly spend hundreds of millions of dollars implementing the operational changes. These non-monetary components are aimed at addressing some of the root causes of the litigation, including enhancing transparency and improving relations with healthcare providers.

The settlement applies to U.S. healthcare providers, including hospitals and certain physicians, who treated Blue Cross patients between July 2008 and October 2024. According to Reuters, the plaintiffs’ attorneys will seek up to $700 million in legal fees from the settlement.

This latest agreement follows a separate $2.7 billion settlement BCBS reached in 2020 to resolve related antitrust claims from commercial and individual subscribers. The U.S. Supreme Court upheld that settlement in June, further solidifying BCBS’s financial and operational commitments in response to these antitrust challenges.

Source: Reuters