SPRINGFIELD, Ill. (CN) - Blue Cross Blue Shield of Illinois will pay $25 million to settle claims that it denied coverage of nursing care for sick children and other fragile patients and fraudulently dumped the costs onto Medicare and Medicaid.
State and federal prosecutors said that Blue Cross Blue Shield denied claims based on internal, undisclosed guidelines that were more restrictive than those it provided to patients.
Blue Cross Blue Shield will pay $14.25 million to Illinois and $9.5 million to the U.S. Treasury to help fund and reimburse Medicaid programs, according to the agreement.
Blue Cross Blue Shield will also pay $1.25 million to Illinois consumers who were denied services and did not receive any Medicaid coverage.
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