Archive for September 11th, 2012

Does Blue Cross Charge A Hidden PPO Access Fee? Are Fees Disguised As A Claim?

Tuesday, September 11th, 2012

See http://www.gpo.gov/fdsys/pkg/USCOURTS-mied-2_11-cv-12557/pdf/USCOURTS-mied-2_11-cv-12557-2.pdf

The plaintiffs are two employers sponsoring self-insured health plans for which Blue Cross Blue Shield of Michigan provided claims administration services and health care provider network access under an Administrative Services Contract. “These cases are about certain fees that Blue Cross allocated to itself as additional administrative compensation…. Section 1106(b)(1) prohibits a fiduciary from ‘deal[ing] with the assets of the plan in his own interest or for his own account.’ This is plainly what Blue Cross did when it unilaterally determined the amount of Disputed Fees to keep as part of its administrative compensation and collected those fees from plan assets. Because Section 1106(b)(1) sets forth ‘an absolute bar against self dealing’ by a fiduciary, Blue Cross is liable.” [Boroughs Corporation v. Blue Cross Blue Shield of Michigan, No.11-12565 (E.D. Mich., Sept. 7, 2012)]