Cancer Docs v. Blue Cross Proceeds

ATLANTA (CN) - A Fulton County Superior Court judge will meet today with attorneys for oncologists and Blue Cross and Blue Shield of Georgia, which the doctors accuse of shortchanging them for cancer care. In the status conference, a timeline will be set for Northeast Georgia Cancer Care v. Blue Cross Blue Shield Healthcare Plan of Georgia, and plaintiffs will address their motion to compel discovery.

Physicians who operate as Northeast Georgia Cancer Care accuse the insurer of arbitrarily lowering reimbursement rates for cancer infusion treatments, in breach of 2007 HMO contracts. The named defendant is a subsidiary of Blue Cross and Blue Shield of Georgia, according to the complaint filed in December.

The plaintiffs sued in September 2008 over the 2007 PPO contract and Participating Physician Agreement in September and amended the complaint in October to add the 2007 HMO contract.

In response, Blue Cross sought to compel arbitration and to dismiss or stay proceedings pending arbitration. The insurer claims the doctors circumvented the arbitration process by filing the lawsuit.

A Fulton County Superior Court judge ordered the parties to settle the dispute over the 2007 PPO contract and the Participating Physician Agreement in arbitration but said the plaintiffs were free to file another complaint over the 2007 HMO contracts. The parties met on April 6 to settle the PPO case in arbitration; the arbitrator is expected to make a decision this month.

"BCBS agreed that it would pay the physicians at the rates that went along with their contract instead of the lower rates that BCBS subsequently paid," said Loretta Goodson, practice administrator for Cancer Care. "The arbitrator also has under consideration the question of whether an award of attorneys' fees in favor of the physicians is appropriate."

The parties had a similar lawsuit pending before the Georgia Court of Appeals. Reimbursement rates for oncology contracts were disputed in this case, initially filed in 2007 in Clarke County Superior Court. The dispute led to Cancer Care's being left out of the HMO network for medical oncology, Goodson said. An appeals court in March supported a lower court's dismissal of claims against BCBS. Cancer Care has asked the appeals court to reconsider that decision.

Goodson said she expects a different result in the current HMO and PPO cases.

We remain optimistic and stand behind the facts in our case," Goodson said.

The doctors are represented by James W. Boswell with King & Spalding.

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