Doctors Can’t Sue Blue Cross Again

     (CN) – Settlements in previous multidistrict litigation preclude physicians from bringing claims against Blue Cross/Blue Shield for conspiring to underpay doctors, a federal judge ruled.
     In the multidistrict class action Thomas v. Blue Cross and Blue Shield Ass’n, doctors claimed that WellPoint, Blue Cross/Blue Shield, and Highmark conspired to systematically “deny, delay, and diminish payments to them,” according to the dismissal order in Miami Federal Court.
     Each defendant settled between 2005 and 2007, agreeing to pay class members and changes their business practices.
     The insurers paid class members more than $384 million, and spent $535 million making internal changes, which had an estimated value to the class of more than $3 billion.
     In return, the plaintiffs signed broad releases prohibiting them from bringing their claims back to court.
     But in January this year, Dr. Corey Musselman filed a class action based on similar claims, and sought a declaration that the settlement agreements did not preclude his case.
     U.S. District Judge Federico Moreno last week found for the insurance companies, and ruled that Musselman’s claims were released under the prior litigation.
     “The settlement agreement is clearly intended to embrace all potential claims and not merely those that were expressly pled at the time the record was frozen based on the parties’ decision to conduct settlement negotiations,” Moreno wrote.
     Musselman tried to distinguish between “denied, delayed, or diminished payments,” and manipulation of the rates of reimbursement.
     But “the court rejects plaintiffs’ argument that rates of reimbursement are not aspects of fee for service claims but are more accurately considered aspects of the agreements between providers and defendants. This distinction is artificial. The amount a physician is paid is plainly an aspect of a fee for service claim, whether or not reimbursement is addressed in a contract or agreement between a participating provider and an insurer,” the 14-page opinion states.
     Moreno concluded, “Here, the cause of action alleged so clearly relates to matters of underpayment and non-payment of fee-for-service claims, the court has no choice but to dismiss those claims.”

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