Five legal actions involving payers were taken in the last week, including a lawsuit against a former Anthem president and a denial of Optum's bid to drop a case.
1. Blue Cross Blue Shield Healthcare Plan of Georgia will end its "avoidable emergency room" program March 18, prompting the American College of Emergency Physicians and the Medical Association of Georgia to withdraw a lawsuit against the policy. The program was instituted to prevent inappropriate use of the ER and encourage members to connect with primary care or urgent care providers. Georgia's medical association and the ER physicians group argued it would result in violations of patient protections.
2. Anthem filed a lawsuit March 7 against one of its former presidents who oversaw a Nebraska Medicaid program. The case alleges he stole trade secrets and breached agreements related to his restricted stock.
3. The U.S. Supreme Court denied Optum's bid to drop a class-action lawsuit March 7, which alleges the company worked with Aetna and used "dummy code" to make administrative fees appear to be billable medical charges. The case will be sent back to the 4th U.S. Circuit Court of Appeals for a decision.
4. A man is suing Aetna Life Insurance in the U.S. District Court for the Central District of California, alleging that its denials of lumbar artificial disc replacement surgery violate the Employee Retirement Income Security Act. He alleges that Aetna has repeatedly violated the act by denying services for lumbar artificial disc replacement surgery by determining them "experimental and investigational," and therefore excluded from coverage, according to the court documents. Mr. Howard is seeking class-action status for the lawsuit.
5. A New York judge ruled that New York City cannot penalize retirees who decline to participate in a new retiree Medicare Advantage plan provided by EmblemHealth and Anthem subsidiary Empire Blue Cross Blue Shield.