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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.


Ohio Board of Pharmacy | Administrative Code Rule Changes

The Ohio Board of Pharmacy (“BOP”) recently posted notices of Ohio Administrative Code rule changes related to record keeping and the sale and distribution of certain ephedrine-containing products.

A Shift in Coverage: HHS Reinterprets “Federal Public Benefit” Under PRWORA

The U.S. Department of Health and Human Services rescinded a 1998 interpretation of “federal public benefit” used in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) on July 10, 2025. This notice removes "outdating exclusions" and includes additional programs under “federal public benefit."

Supreme Court Upholds Coverage under the Affordable Care Act

The U.S. Supreme Court has upheld the authority of the U.S. Preventive Services Task Force under the ACA, ensuring continued no-cost coverage for over 100 preventive health services. The decision impacts millions of Americans and preserves provider reimbursement through insurance.

Health Care Providers Take Note: Federal Budget Brings Medicaid and Staffing Rule Changes

The 2025 federal budget introduces significant changes for health care providers and Medicaid recipients, including new cost-sharing requirements, work eligibility mandates, rural health grants, and a pause on minimum staffing rules.

Key Healthcare Provisions in Ohio’s 2026–2027 Budget

Ohio’s newly enacted biennial budget (HB 96) for FY 2026–2027 brings sweeping changes for healthcare providers across the state. The law includes new Medicaid eligibility requirements, reporting mandates, funding directives, and social policy provisions. Several vetoes by Governor DeWine also affect healthcare-related initiatives.