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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.


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.

Ohio Recovery Housing Operators Beware: House Bill 58 Seeks to Make Major Changes

Ohio House Bill 58 proposes significant changes to recovery housing oversight, granting ADAMH Boards authority to inspect and investigate recovery residences. The bill also introduces a Certificate of Need (CON) program, requiring state approval for major facility changes. OMHAS will assess applications based on cost, quality, accessibility, and financial feasibility. The bill also establishes a recovery housing residence fund to support inspections. For more information, contact BMD attorneys Daphne Kackloudis or Jordan Burdick.

January 2025 Notice of Proposed Rulemaking Brings Notable Changes to HIPAA Security Rule

In January 2025, the U.S. Department of Health and Human Services proposed amendments to the HIPAA Security Rule, aiming to enhance cybersecurity for covered entities (CEs) and business associates (BAs). Key changes include mandatory compliance audits, workforce training, vulnerability scans, and risk assessments. Comments on the proposed rule are due by March 7, 2025.

Corporate Transparency Act Effective Again

The federal judiciary has issued multiple rulings on the enforceability of the Corporate Transparency Act (CTA), which took effect on January 1, 2024. Previously, enforcement was halted nationwide due to litigation in Smith v. U.S. Department of the Treasury. However, on February 18th, the court lifted the stay, reinstating the CTA’s reporting requirements. Non-exempt entities now have until March 21, 2025, to comply. Businesses should act promptly to avoid civil penalties of $591 per day and potential criminal liability.

Status Update: Physician Noncompete Agreements in Ohio

Noncompete agreements remain enforceable in Ohio if they meet specific legal requirements. While the AMA and FTC have challenged these restrictions, courts continue to uphold reasonable noncompete provisions for physicians. Recent cases, like MetroHealth System v. Khandelwal, highlight how courts may modify overly restrictive agreements to balance employer interests with patient care. With ongoing legal challenges to the FTC’s proposed ban, Ohio physicians should consult a healthcare attorney before signing or challenging a noncompete agreement.