Most California Physicians Eligible for New Blues Settlement
[Posted 04/24/08]

Another settlement has been reached in the racketeering lawsuit against the Blue Cross/Blue Shield Association, which alleges that the insurers’ payment practices defrauded physicians out of payments for patient care. Most California physicians will be eligible for this latest settlement, which was reached with Capital Blue Cross, Capital Advantage Insurance Company, and Keystone Health Plan Central.

The class includes all physicians who billed any of the Blues companies or their contracted intermediaries (capitated medical groups, IPAs, etc.) for services provided between January 1, 1996, and March 12, 2008. Most California physicians will only be entitled to one settlement share. Physicians who treated even one patient from any of the settling health plans will receive 10 shares.

The deadline to submit a claim is June 30. Physicians do not have to provide documentation for individual claims. If you wish to opt out of the settlement, you must do so by May 30.

The case, Rick Love, M.D. v. Blue Cross Blue Shield Association, was filed in May 2003 in federal district court in Miami. The suit accused the insurers of a pattern and practice of denying and delaying care, including intentionally programming computer billing databases to automatically downcode physician claims. The suit was filed under the federal civil racketeering (RICO) statutes. Although CMA is not a plaintiff in the suit, the suit affects all physicians because of its class-action status.

For more information on the RICO settlements click here.

Contact: CMA's reimbursement help line, 888/401-5911 or drice@cmanet.org.