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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.


ODM to Implement Medicaid Work Requirements: What Providers and Medicaid Expansion Recipients Need to Know

The Ohio Department of Medicaid (ODM) has submitted a waiver to impose work requirements for Medicaid expansion recipients. If approved, the new eligibility criteria will take effect on January 1, 2026. A federal public comment period is open until April 7, 2025.

Ohio Appellate Court Rules in Favor of Gender-Affirming Care

On March 18, 2025, the 10th District Court of Appeals in Franklin County ruled that Ohio’s House Bill (HB) 68, which restricts puberty blockers and hormone therapy for minors seeking gender-affirming care, violates the Health Care Freedom Amendment and is therefore unenforceable. The court found that the law unlawfully interferes with parental rights and medical decision-making. The case, Moe v. Yost, has been remanded, and Ohio Attorney General Dave Yost intends to appeal.

HHS Revokes Public Comment Requirement on Certain Policy Changes

The U.S. Department of Health and Human Services (HHS) has revoked the Richardson Waiver, eliminating the requirement for public notice and comment on certain policy changes. This decision allows HHS to implement new policies more quickly, potentially affecting healthcare funding rules like Medicaid work requirements. While it speeds up policymaking, it also reduces opportunities for stakeholder input, raising concerns over transparency and unintended consequences for healthcare providers, states, and patients.

Don't Get Caught Dazed and Confused: Another Florida Court Weighs in on Employer Obligations to Accommodate Medical Marijuana Use

A Florida trial court ruled in Giambrone v. Hillsborough County that employers may need to accommodate off-duty medical marijuana use under the Florida Civil Rights Act (FCRA). This contrasts with prior rulings and raises new compliance challenges for employers. With the case on appeal, now is the time to review workplace drug policies.

Corporate Transparency Act to be Re-evaluated

Recent federal rulings have impacted the enforceability of the Corporate Transparency Act (CTA), which took effect on January 1, 2024. While reporting requirements were briefly reinstated, FinCEN has now paused enforcement and is reevaluating the CTA. Businesses are no longer required to submit reports until further guidance is issued. For updates and legal counsel, contact BMD Member Blake Gerney.