News

Court holds that Blue Cross Blue Shield defendants are subject to per se standard of review in in re Blue Cross Blue Shield Antitrust litigation

Judge R. David Proctor held that certain of the conduct of the Blue Cross Blue Shield defendants in a mammoth healthcare antitrust action pending in the Northern District of Alabama are subject to the per se standard of review, which holds that types of activity are per se violations of the antitrust laws. Accordingly, the Court granted plaintiffs’ motion for summary judgment as to this conduct.

There are two tracks in this litigation: a subscriber track and a provider track. The provider track alleges that the Blue Cross Blue Shield defendants – each of the individual BCBS health insurers across the country and the Blue Cross Blue Shield Association – engaged in antitrust violations to pay health care providers less than they would have received by fixing these rates and engaging in a monopsony.

Robert J. Axelrod of Axelrod LLP is a committee chair for the provider track in this important litigation. Click here to read the opinion.

Axelrod LLP files action on behalf of surgical center against Aetna Insurance Company for pending claims in its special investigation unit

Axelrod LLP filed a federal ERISA complaint in the Western District of Washington on behalf of its client Puget Sound Surgical Center, P.S. against Aetna Insurance Company and a number of individual self-funded health care plans, alleging that the funds either paid nothing or underpaid Puget Sound’s claims, and Aetna pended many of the claims by placing them in its Special Investigations Unit.

Although all health insurers have a Special Investigations Unit (“SIU”) to investigate fraudulent claims, the complaint alleges that Aetna never brought an action against Puget Sound for fraud. Instead, it simply flagged its claims and stopped paying most of them, in violation of ERISA, which governs employer-based health care plans. This is a common practice among health care insurers.

Senior Partner Robert J. Axelrod and Partner Michael Fried represent Puget Sound. Click here to read the complaint.