On Feb. 25, physician staffing groups filed a federal antitrust lawsuit in California against the BCBS Association and over 30 of its licensees — along with plan owners Elevance Health, Highmark, GuideWell, Cambia Health Solutions and Health Care Service Corp.
The latest lawsuit was brought about in part by American Physician Partners and NES America, which are now defunct. The parties had opted out of an earlier settlement that sought to resolve antitrust claims against BCBS.
This lawsuit accused the BCBS Association and its plans of market allocation with exclusive services areas, ongoing harm from the insurer’s “Best Efforts” rules regarding output restrictions and monopsony power in provider markets. This prompted “non-negotiable, sub-competitive” reimbursement, the complaint said.
“When one Blue has a contract dispute or issue with a healthcare provider, the other Blues, as independent horizontal parties and as horizontal parties through BCBSA, act to reinforce the market power of each of the Blues,” the filing said.
The lawsuit also claimed price fixing through BlueCard and National Accounts programs, which offer provider access beyond a designated geography and support multi-state employers, respectively.
The suing parties are seeking trebled damages, injunctive relief and ongoing judicial oversight. The lawsuit does not specify a dollar amount for damages.
BCBS has faced a handful of antitrust lawsuits in recent years. In 2022, a judge approved a $2.67 billion settlement brought by customers over anticompetitive behavior. The U.S. Supreme Court eventually rejected challenges to this settlement. The case also axed the BCBS National Best Efforts rule outlining that two-thirds of net revenue needed to come from Blue-branded products. More recently, a $2.8 billion settlement aimed to resolve antitrust claims from providers. However, nearly 6,500 providers opted out of the settlement, with newer lawsuits springing up that questioned the settlement’s adequacy.
The BCBS Association told Becker’s it does not have a comment on this active litigation.
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