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Blue Cross Blue Shield Provider Settlement Opportunity

Client Alert

In re: Blue Cross Blue Shield Antitrust Litigation, MDL 2406, N.D. Ala., Master File No. 2:13-cv-20000-RDP is pending in the United States District Court for the Northern District of Alabama, and both parties have agreed, as of October 4, 2024, to a Settlement. If approved by the court, the Settlement will establish a $2.8 billion Settlement Fund. To participate in the Settlement, you must be a provider who meets the eligibility criteria described below and must submit the claim by July 29, 2025, online or by mail.

According to the BCBS Provider Settlement Website (BCBS PSW) there are two types of claims that can be filed: a professional claim and a facilities claim. Medical Professionals, Medical Groups, and Medical Organizations , which include any association, partnership, corporation or other form of organization that arranges for care to be provided to Blue Plan Members by Medical Professionals organized under multiple taxpayer identification numbers, should utilize the professional claim. Health Care Facilities, including any facility in which health care services are or were delivered to Blue Plan Members, and Health Care Systems (defined as any association, partnership, corporation or any other organization that arranges for care to be provided to Blue Plan Members by two or more Health Care Facilities organized under multiple taxpayer identification numbers), should utilize the facilities claim. Note that if a Medical Group is submitting a professional claim, the medical professionals who work for the Group must authorize the Group to submit a claim on their behalf, and the medical professionals cannot then also submit Claim Forms on their own behalf.

To be eligible to receive portions of the settlement, you must be a provider who currently provides or did provide healthcare services, equipment or supplies to any patient who was insured by, or was a Member of or a beneficiary of, any plan administered by any Individual Blue Plan during the Settlement Class Period of  July 24, 2008 to October 4, 2024. Providers constitute any person or entity that provides healthcare services in the U.S.

Providers who are excluded from the class and ineligible for the settlement include:

  1. Providers owned or employed by BCBS;
  2. Providers owned or employed exclusively by Government Entities, or Providers that exclusively provided services, equipment or supplies to members of or participants in Medicare, Medicaid, or the Federal Employee Health Benefits Programs;
  3. Providers that have otherwise fully released their Released Claims against BCBS prior to the Execution Date, including but not limited to Providers that were members of any of the settlement classes in Love v. Blue Cross and Blue Shield Association; and
  4. Providers that exclusively provide or provided: (a) prescription drugs; (b) durable medical equipment; (c) medical devices; (d) supplies or services provided in an independent clinical laboratory; or (e) services, equipment or supplies covered by standalone dental or vision insurance.

A claim for payment can be submitted online or by mail. Class members who submit a valid approved claim become Authorized Claimants. Ninety-two percent of the Settlement Fund will be allocated to Health Care Facilities and Health Systems, and eight percent will be allocated to Health Care Professionals.

For More Information, please contact BMD Healthcare Members Daphne Kackloudis at dlkackloudis@bmdllc.com or Amanda Waesch or alwaesch@bmdllc.com.


CMS Releases CY 2026 Medicare Physician Fee Schedule Final Rule with Key Payment and Telehealth Updates

CMS issued the CY 2026 Medicare Physician Fee Schedule Final Rule on October 31, 2025, with changes effective January 1, 2026. The Final Rule includes increases to the conversion factor, a new efficiency adjustment, updates to practice expense methodology, permanent telehealth policy changes, revised payment for skin substitutes, expanded rules for Part B drugs and biologicals, enhanced policies for Rural Health Clinics and Federally Qualified Health Centers, and new care management and behavioral health services.

Ohio Department of Medicaid Updates: Key Changes to Physician Reimbursement Rates in Early Parenthood

The Ohio Department of Medicaid has proposed amending Ohio Administrative Code Rule related to covered Medicaid reimbursements for physicians. Beginning on January 1, 2026, they are proposing an increase to rates for prenatal care, childbirth, and infant care and provider visits.

Name, Image, and Likeness Agreements in Healthcare

For example, some healthcare providers have begun to utilize "Name, Image, and Likeness" agreements to promote the brand they have created through their healthcare practice.  We have seen the most healthcare NIL activity with longevity and wellness providers, as well as orthopedics.

Compounding GLP-1 Drugs - Recent Updates

Recent guidance from the Ohio Board of Pharmacy (“BOP”) indicates that providers should generally use the FDA approved GLP-1 drug, rather than a non-FDA approved compounded version of the medication. Importantly, if a GLP-1 drug is commercially available, it cannot be copied through compounding. Currently, compounded copies of Tirzepatide and Semaglutide are not permitted.

Top Compliance Risks for Ohio Med-Spas in 2025

The Ohio Board of Pharmacy has increased inspections of med-spas holding Terminal Distributor of Dangerous Drugs (TDDD) licenses, with many facing enforcement actions in 2025. Common issues include purchasing from unlicensed distributors, improper drug storage, inadequate recordkeeping, and insufficient prescriber oversight. Understanding these risks and maintaining compliance can help protect your practice from penalties and license suspension.