Lane Regional Medical Center in Zachary has become the latest plaintiff in an antitrust case advancing in Alabama federal court, alleging Blue Cross and Blue Shield insurers are functioning as an illegal cartel.
A complaint filed in Baton Rouge federal court late Friday does not name Blue Cross and Blue Shield of Louisiana as a defendant, but accuses 71 other companies of having “conspired with Blue Cross and Blue Shield of Louisiana,” and accuses BCBSLA of “overt acts in furtherance of those conspiracies in Louisiana” to reimburse health care providers at rates below competitive levels for services.
The 133-page lawsuit, filed by Baton Rouge attorney Lewis Unglesby and lawyers from other states, claims LRMC provided services to patients insured by Blue Cross through its in-network contract, but “was paid less for those services than it would have been but for … anticompetitive conduct. … LRMC has been injured in its business or property as a result of defendants’ violations of the antitrust laws.”
The lawsuit notes that BCBSLA has a 57% market share in the state, and a 52% market share in Baton Rouge.
BCBSLA spokeswoman Robin Mayhall referred all questions to the Blue Cross and Blue Shield Association.
“This is a model that has withstood scrutiny over our entire history,” Scott Nehs, association general counsel told The Wall Street Journal in May. “There’s no smoky room involved, there’s no dividing up.”
Blue Cross and Blue Shield health insurers cover about a third of Americans through a national network that dates back decades. A federal judicial panel has consolidated the claims against the insurers into two lawsuits that represent plaintiffs from around the country. One is on behalf of health care providers; the other, for individual and small-employer customers. The multidistrict litigation is pending in Alabama.
The antitrust suits allege that the insurers are conspiring to carve up markets and avoid competing against one another, driving up prices for coverage and shrinking the amounts paid to doctors and other health care providers. A U.S. District judge in Alabama last year refused to dismiss the cases, ruling that the plaintiffs “have alleged a viable market-allocation scheme,” which, if proven, could be an antitrust violation under the Sherman Act.
—Penny Font
