Health System Accuses Blue Cross Blue Shield of Collusion in Federal Lawsuit

Mount Nittany Health has filed a federal lawsuit alleging that the Blue Cross Blue Shield Association and its affiliated insurers have engaged in long-standing collusion to suppress competition and underpay healthcare providers, violating antitrust laws. The legal action, submitted Thursday in the U.S. Middle District Court of Pennsylvania, places the State College-based health system among numerous healthcare providers challenging the practices of the nation’s largest health insurers.

According to the lawsuit, Blue Cross Blue Shield insurers have allegedly divided exclusive geographic regions among themselves, preventing competition and using restrictive agreements to maintain artificially low reimbursement rates for healthcare providers. Per the lawsuit, these practices have resulted in significantly lower payments to providers than they would have received in a truly competitive market.

The legal filing comes in the wake of a national class-action settlement related to similar allegations in an Alabama case, where Blue Cross Blue Shield agreed to a $2.8 billion settlement without admitting any wrongdoing. The settlement is expected to be finalized in July, and Mount Nittany Health is among the providers that opted out, choosing instead to pursue its claims independently. The lawsuit specifically names Highmark, Capital, and Independence as defendants while listing multiple Blue Cross Blue Shield licensees as co-conspirators.

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According to a statement included in the lawsuit, the agreements that prevent insurers from enrolling customers or negotiating provider rates outside their designated territories effectively limit market expansion. The lawsuit asserts that if these insurers, which operate independently but are bound by their Blue Cross affiliation, were to establish provider networks in new areas, increased competition would drive up reimbursement rates for healthcare providers.

The lawsuit also contends that Blue Cross Blue Shield insurers leverage their combined market power and widespread name recognition to suppress payment rates below what would be expected in a competitive market. Healthcare providers, the suit alleges, have little negotiating power and face the risk of losing all Blue Cross Blue Shield patients if they refuse to comply with the restrictive agreements.

Per the complaint, these anticompetitive actions have allowed the insurers to pay in-network providers at rates significantly below fair market value. Mount Nittany Health is seeking triple the amount of its unspecified damages, along with interest, attorneys’ fees, and an injunction barring the Blue Cross Blue Shield insurers from continuing the practices alleged to violate antitrust laws.

Source: State College