5 recent legal actions, settlements involving payers

From Excellus BlueCross BlueShield settling a data breach lawsuit impacting millions of members to GS Labs accusing Blue Cross and Blue Shield of Kansas City of violating antitrust laws, here are five recent legal actions and settlements involving payers.

1. A judge sided with two cancer patients Jan. 27 in a class-action lawsuit against Aetna. The court ruled Aetna unlawfully denied proton beam radiation therapy, which was deemed medically necessary following recommendations from the patients' oncologists. 

2. Aetna Better Health Care and My Health by Health Providers of Morrisville both withdrew appeals after suing the North Carolina Health and Human Services Department over its Medicaid contract selection process in 2019. A judge had ruled against the parties twice already on the matter. 

3. Excellus BlueCross BlueShield tentatively settled a class-action data breach lawsuit from 2015. The payer and the Blue Cross Blue Shield Association will have to pay out $4.3 million and increase security of member information. 

4. The state of Georgia is suing HHS after the agency implemented changes that removed a requirement for Medicaid beneficiaries to work in order to be eligible for coverage. HHS rescinded the work requirement in December with the justification that it would better protect residents through pandemic-related disruptions. 

5. GS Labs responded to a July 2021 lawsuit from Blue Cross and Blue Shield of Kansas City with counterclaims accusing the payer of violating federal antitrust laws, among other offenses. The lab accused the payer of trying to prevent GS Labs' expansion into Missouri, conspiring with other Blue Cross Blue Shield affiliates to deny payments, defaming the lab and interfering with its business relationships.

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