OVERVIEW - This report proposes a vision and plan for action—collectively a statewide Health Equity Action Plan—for achieving a racially and ethnically equitable health care delivery system in Massachusetts. The report is...more
Attorneys Matthew M. Lavin and Aaron R. Modiano recently secured a complete denial of Blue Cross & Blue Shield of Michigan’s Motion to Dismiss a $40+ million dollar lawsuit brought on behalf of behavioral health providers for...more
While too many of us get overdosed with clownish depictions - from doctors, hospitals, insurers, and corporations, especially Big Pharma firms - of how the civil justice system operates, it’s always worth a reminder of the...more
The year 2020 was an eventful one in the world of healthcare antitrust. The year began with the announcement of the precedent-setting settlement of the California Attorney General’s action against Sutter Health and ended with...more
Compliance Today (December 2020) - The Blue Cross Blue Shield insurance group has negotiated a possible settlement to sweeping antitrust lawsuits that alleged the group benefited from anticompetitive measures that...more
After over 8 years of hard-fought litigation, the Blue Cross and Blue Shield Association, together with its 36 Blue Cross/Blue Shield members (“the Blues”), recently announced a proposed settlement of class action antitrust...more
In this week’s episode, Gary Qualls discusses a recent case decided in the Western District of Louisiana, which highlights how the application of the arbitrary and capricious standard as applied to payor coverage...more
North Carolina District Court Permits Plan’s Lawsuit Against Third Party Administrator to Continue A federal district court in North Carolina has ruled that a plan subject to the Employee Retirement Income Security Act of...more
Report on Patient Privacy 20, no. 1 (January 2020) - ? A cybersecurity breach temporarily halted cancer radiation treatment services at the Cancer Center of Hawaii on Oahu,[1] the center said. The center, which provides...more
Massachusetts Governor Charlie Baker has restarted the discussion on health care cost containment in the Commonwealth with a proposed bill that contains a raft of initiatives. This is the first in a series of blog posts to...more
The Federal Trade Commission has issued orders to five health insurers and two health systems requiring them to provide information that will assist the FTC in studying the competitive effects of certificates of public...more
On June 5, 2019, in the matter Kerry W. v. Anthem Blue Cross and Shield, No. 2:19cv67, Judge Dee Benson of the U.S. District Court for the District of Utah granted Anthem Blue Cross and Shield’s motion to dismiss the...more
Serving over 1.8 million Massachusetts residents, MassHealth provides access to healthcare services for people of varying ages and life circumstances across the Commonwealth. These services improve enrollees’ health and...more
The Third Circuit reinstated an antitrust suit brought by a medical device seller that alleged Blue Cross Blue Shield Association and five of its member insurance plan administrators shut out the seller by conspiring to deny...more
In a somewhat unexpected but highly significant move, United States District Judge David Procter (Northern District of Alabama), who is presiding over the In re Blue Cross Blue Shield Antitrust Litigation (Case No....more
On April 23, a federal court in Rhode Island fired a warning shot over the bow of dominant health insurers across the country, holding that a refusal to negotiate in good faith with a healthcare provider that focuses...more
Three health insurers accused of having violated the antitrust laws in Academy of Allergy & Asthma in Primary Care v. Blue Cross Blue Shield of Louisiana, et al. (Eastern District of Louisiana), have filed motions seeking a...more
In what was a surprise result, on April 23, Judge William Smith (Chief Judge of the District of Rhode Island) reversed the “tentative” decision he had announced last November, in Stewart Health v. Blue Cross & Blue Shield of...more
On April 5, 2018, a Federal court held that Blue Cross health insurance plans’ “aggregation of a market allocation scheme” will be analyzed under the per se standard of antitrust review, which treats categories of restraints...more
On April 5, United States District Judge David Proctor (N.D. Alabama) granted partial summary judgment to the plaintiffs in the In re Blue Cross Blue Shield Antitrust Litigation, ruling that a network of trademark licensing...more
The decision of Blue Cross of Idaho to offer health insurance plans that appear to violate federal law begins the latest chapter in the continuing saga of the Affordable Care Act’s increasingly tenuous existence. Blue Cross...more
As 2017 drew to a close, some health plans and healthcare providers across the country were still busy trying to finalize contracts for in-network services for 2018 and beyond. A number of negotiations made the headlines in...more
Blue Cross Blue Shield of Florida (Florida Blue) has announced that 475 applications for insurance were backed up to the cloud, on an unsecured cloud server, by an unaffiliated agent of Real Time Health Quotes, and exposed...more
As the trend of acquisitions of physician practices and mergers of hospitals continues, so does antitrust scrutiny of these deals. There was activity this week in three different proposed transactions that caught the...more
In the latest sign that data breach class actions are here to stay—and, indeed, growing—the D.C. Circuit resuscitated claims against health insurer CareFirst BlueCross and Blue Shield, following a 2015 breach that compromised...more