Lawsuit accuses BCBS of Massachusetts of systematically allowing overpayments

A laborers fund in Massachusetts filed a lawsuit against its health insurance administrator, Blue Cross Blue Shield of Massachusetts, claiming the insurer's pricing led to millions of dollars in overpayments to providers.

The Massachusetts Laborers' Health and Welfare Fund filed the lawsuit March 26 against BCBS of Massachusetts in the U.S. District Court of Massachusetts. According to the lawsuit, BCBS of Massachusetts was hired to administer the fund's health insurance services for its self-insured health plan and make benefit determinations on how much the fund should reimburse healthcare providers.

In its lawsuit, the fund claims BCBS of Massachusetts violated its fiduciary duties under the Employee Retirement Income Security Act by prioritizing "its relationships with healthcare providers and its own bottom line" when pricing health insurance claims.

"BCBSMA allowed millions of dollars of billing [errors] to deplete the Fund's assets and obstructed the Fund's efforts in recovering overpayments," the lawsuit alleges. "BCBSMA failed to correct the systemic issues that gave rise to such costly errors in the first place."

In a written statement emailed to Becker's, a BCBS of Massachusetts spokesperson said the insurer rejects "the erroneous claims made in this complaint, which misstates facts and mischaracterizes many events."

The insurer continued: "The allegations in the complaint illustrate an incomplete and misguided understanding of BCBSMA's claims pricing systems. BCBSMA intends to take action against this vendor for the harm it has caused our business relationships."

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Top 40 articles from the past 6 months