Aetna Files Antitrust Suit Against Blue Cross Blue Shield of Michigan

The Wall Street Journal (12/7, Mathews, Subscription Publication) reports that Aetna has sued Blue Cross Blue Shield of Michigan for allegedly paying hospitals to charge other insurers up to 39% more than they charged Blue Cross, making it difficult for others insurers to compete.

        Bloomberg News (12/7, Pettersson) reports, “Blue Cross Blue Shield of Michigan in August lost a bid to dismiss a joint US-state lawsuit accusing it of driving up competitors’ costs through preferential pricing contracts with hospitals. In some cases, hospitals charged rivals 30 percent to 40 percent more than Blue Cross, the US Justice Department has said.” The current “case is Aetna v. Blue Cross Blue Shield of Michigan, 11-15346, US District Court, Eastern District of Michigan (Detroit.).”

        The Detroit News (12/7, Burden) reports, “Aetna…filed an antitrust lawsuit Tuesday in Detroit federal court against Blue Cross Blue Shield of Michigan, alleging the state’s largest insurer has prevented Aetna from expanding in Michigan.” Aetna’s “lawsuit is a piggyback on the fall 2010 suit by the US Justice Department and former Michigan Attorney General Mike Cox that accuses the Blues of using special hospital contracts, or most-favored nation clauses, that stifle competition and drive up rates for consumers.” Michigan Association of Health Plans deputy director Paul Duguay remarked that the lawsuit will “at a minimum” shed “greater light on those practices and, if successful, stands to foster greater competition in Michigan” for health plans other than Blue Cross.

        The Detroit Free Press (12/7, Anstett) notes that “The Aetna case is significant because other insurers and Michigan hospitals have stayed out of the fight with Michigan’s largest insurer, which covers about 60% of Michigan’s residents with health insurance. Only the city of Pontiac, an outstate business and a lone consumer have filed so-called piggyback lawsuits against the Blues alleging improper pricing practices.” In 2005, Aetna paid “nearly $390 million…to acquire a Michigan-based health care network, HMS Healthcare, in hopes to building a statewide plan of services for employers and individuals buying Aetna insurance. HMS operates in Michigan under the name PPOM.”

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