Health insurers Anthem (NYSE:ANTM), UnitedHealth Group (NYSE:UNH), and Centene (NYSE:CNC) all reached all-time highs on Friday.
Author Archives: Admin
Health Care Is In DOJ’s Criminal Antitrust Crosshairs 
By: Dylan Carson and Antonio Pozos
Law360
Criminal antitrust enforcement in health care has picked up significantly in recent years and remains in sharp focus for companies and executives today. The U.S. Department of Justice Antitrust Division has made enforcement in health care a top priority, as the prosecution of alleged conspiracies to fix the wages of health care workers and agreements not to compete for their services is playing out in courtrooms across the country.
For example, the trial in U.S. v. DaVita, the DOJ’s prosecution of kidney dialysis company DaVita Inc. and its former CEO regarding an alleged no-poach agreement, began in the U.S. District Court for the District of Colorado on April 4.
The Bottom Line: Blue Cross Blue Shield of Illinois president out after Target 3 investigation
By: Mark Maxwell
WCIA.com
A senior communications manager for Blue Cross Blue Shield of Illinois confirmed the authenticity of the internal memo but did not address whether Steve Hamman was fired.
SPRINGFIELD, Ill. (WCIA) — Blue Cross and Blue Shield of Illinois (BCBSIL) President Steve Hamman is out, according to an internal memo Target 3 investigators obtained Thursday. Sources inside the BCBSIL headquarters in Chicago told reporters he was fired following our reporting that exposed the company is overcharging consumers while cutting down — sometimes cutting out — their provider options.
‘I need answers’: lawmakers grill Blue Cross Blue Shield, Springfield Clinic in hearing
By: Andrew Adams
State Journal-Register
In a legislative hearing on Wednesday evening, lawmakers met with representatives of Blue Cross Blue Shield of Illinois, Springfield Clinic and the state Department of Insurance.
The hearing was to investigate the relationship between Blue Cross Blue Shield and Springfield Clinic. After the two organizations failed to reach a contract agreement last year, the insurer cut Springfield Clinic from its network in November.
UMMC goes out-of-network with Blue Cross Blue Shield
By: Will Stribling
04/01/2022
Mississippi Today
Mississippi’s largest hospital went out of network with the state’s largest insurer on Friday, meaning thousands of Mississippians will now face higher out-of-pocket costs for their health care or be forced to leave the state for certain specialty care.
This is the first time the state’s only academic medical center has officially gone out of network and not had an active contract with Blue Cross Blue Shield of Mississippi, according to UMMC officials’ knowledge.
Even though representatives for both sides have been meeting in person each week since January, the two entities were not able to agree to a new contract before the March 31 deadline.
Georgia fines Anthem Blue Cross Blue Shield $5M fine for claims settlement practices
The Commissioner’s office said Anthem must develop a plan to address the alleged violations
The State of Georgia on Tuesday slapped Anthem Blue Cross Blue Shield with a $5 million fine after determining the health insurance had engaged in a years-long practice of violating policyholder’s rights.
Insurance and Safety Fire Commissioner John F. King announced the fine during a Tuesday morning press conference at the state Capitol, calling it the largest in the agency’s history.
“[A]fter numerous complaints made to our office regarding the operations of Blue Cross Blue Shield from individuals, physicians, hospitals, and others from around the state, I instructed my staff to conduct an extensive examination into the carrier’s practices,” King said.
The examination, which spanned several months, uncovered “serious” issues, King said. These included improper claims settlement practices, violations of state law, failure to reply to consumer complaints in a timely manner, inaccurate provider directories and “significant delays in loading provider contacts.”
Blue Cross Blue Shield under fire from Illinois after cutting Springfield Clinic
By: Andrew Adams
State Journal Register
3/22/2022
The state has officially stepped in to a situation involving the insurance company Blue Cross Blue Shield of Illinois and Springfield Clinic. On Monday, the state’s Department of Insurance announced a $339,000 fine for the company.
The DOI alleges that the Blue Cross Blue Shield failed to appropriately report a “material change” to the insurance company’s network of medical service providers.
The Bottom Line: Blue Cross Blue Shield’s tax-exempt status comes under scrutiny
By: Mark Maxwell, Renee Cooper
WCIA.com
SPRINGFIELD, Ill. (NEXSTAR) — Political pressure is mounting for the Pritzker administration to take swift action to regulate Blue Cross Blue Shield of Illinois after a Target 3 investigation revealed a string of consumer protection concerns stemming from a contract dispute the state’s largest insurer has with Springfield Clinic.
Blue Cross Blue Shield of Illinois has justified its hardball negotiation tactics as an effective strategy to drive reimbursement rates lower at Springfield Clinic, but patients with severe and urgent medical issues are becoming the casualties of the insurance company’s leverage war.
When Blue Cross Blue Shield of Illinois (BCBSIL) kicked hundreds of Springfield Clinic doctors and nurse practitioners out of its network, it effectively blocked 55,000 of its paying customers from visiting their preferred specialists in critical fields, such as obstetricians and radiation oncologists. Springfield Clinic employs most of the area’s specialists in those fields, and often accepts referrals from other primary care doctors at other hospital groups in the capital city.
Blue Cross Blue Shield Of Illinois Fined $339,000 By Illinois Regulators
State Journal Register,
The (Springfield IL)
The state has officially stepped in to a situation involving the insurance company Blue Cross Blue Shield of Illinois and Springfield Clinic. On Monday, the state’s Department of Insurance announced a $339,000 fine for the company.
The DOI alleges that the Blue Cross Blue Shield failed to appropriately report a “material change” to the insurance company’s network of medical service providers.
After the insurer failed to reach a new contract with Springfield Clinic, the company stopped covering services there in July 2021 for members with Health Management Organization plans and on Nov. 17, 2021 for members with Preferred Provider Organization plans, according to the DOI.
BCBS of Florida Sued for Failure to Pay Assigned Benefits, Tracking Tenn. Lawsuit
By Erin Page
Lawstreetmedia.com
On Wednesday a case was filed in the Southern District of Florida by Sovereign Health of California et al against Blue Cross Blue Shield of Florida. The case is regarding the validity of assignments of benefits for members of ERISA-funded health plans; it parallels litigation filed earlier this week. Although the suits were filed by different counsel, and feature a slightly different set of plaintiffs, the claims largely track each other.
The plaintiffs are out of network medical providers in the states of California, Arizona, Florida, and other locations that have provided services to ERISA plan insured members of the defendant. As mental health services providers, the plaintiffs explained that they routinely obtain assignments of benefits from the patients in order to pursue appeals rights with insurance companies without requiring the assistance of the patients, which can be difficult especially for mental health patients.