Blue Cross Faces Antitrust Claims

 John Sherman

Blue Cross Blue Shield faces allegations of anti-competitive behavior that violates the Sherman Antitrust Act of 1890………………………………….

Appeals court rules BCBS must face antitrust claims

Dec 13, 2018

by Evan Sweeney |

Blue Cross Blue Shield must face antitrust allegations filed against the insurer by a group of employers and providers, an appeals court ruled this week.

The 11th Circuit United States Court of Appeals denied an appeal from the insurance giant after a lower court ruled in April that BCBS must defend itself against allegations it engaged in anticompetitive behavior that violates the Sherman Antitrust Act of 1890. The allegations revolve around a decades-old agreement that the majority of the 36 independent companies licensed by BCBS do not overlap service areas.

The court ruled that the case should move forward to determine whether an agreement to limit competition for non-Blues plans is a “per se” violation of the century-old law.

In a written statement, Scott Nehs, senior vice president, general counsel and corporate secretary of Blue Cross Blue Shield Association, said the decision was “not unexpected” and that “pre-trial appeals are rare.”

“This is another step in a very long process and we look forward to continuing to defend our case in the U.S. district court,” he said. “We remain confident that we will ultimately prevail. Blue Cross and Blue Shield companies have been at the heart of the U.S. health care system for almost a century. We provide substantial benefits to medical professionals and currently serve nearly 106 million people with competitive pricing, secure and stable health care coverage and reliable service.”

RELATED: Atrium Health agrees to settle antitrust lawsuit over contract language

It’s the latest in what is expected to be a drawn-out legal battle that has already worked its way through the courts for the last six years. But the decision is another blow to Blues plans who have long weathered accusations of anti-competitive behavior.

Some of those antitrust issues cropped up in Anthem’s attempt to purchase Cigna in 2016. That was eventually blocked the Department of Justice, and a recent lawsuit brought by Anthem shareholders argued that executive knew the Cigna acquisition would violate Blue Cross Blue Shield Association rules that curbed the amount of revenue Anthem could generate from non-Blues plans.

Florida Blue is also facing an antitrust lawsuit from the startup insurer Oscar Health, which claims the Blues plan cut off access to brokers to prevent Oscar from selling ACA plans. The New York insurer has asked the court to issue a preliminary injunction to bar Florida Blue from using those exclusive agreements.


Antitrust Laws Lawsuits Blue Cross Blue Shield Association Anthem