TPA Earns Undisclosed Fees Through Marked Up Hospital Bills?


“these administrative fees were concealed in marked-up hospital claims and “no longer visible” to its customers because they falsely appeared to be money owed to hospitals “

Hi-Lex alleges that Blue Cross acted fraudulently by falsely stating that the Disputed Fees were charges for medical services to be paid to hospitals. In fact, Blue Cross pocketed a portion of these payments as fees to itself, not hospitals, from assets of the plan that it controlled without authorization from Hi-Lex