A jury has awarded $421 million in damages to a group of Louisiana doctors after finding Blue Cross Blue Shield committed fraud and abuse of rights. The insurance company was found to have withheld payments for approved procedures, including breast reconstruction following cancer treatment, at the Center for Restorative Breast Cancer. “This landmark victory not only holds Blue Cross and Blue Shield of Louisiana accountable but also exposes a hidden problem in our system,” said Dr. Frank DellaCroce. “This has been very difficult, but we are pleased that the jury saw the truth. It is a victory for all those who have felt bullied by big corporate health insurance and the self-serving things they do to drain resources from care delivery. We work the long hours, we pioneer advancements, we take care of these women, and we fought back for those who work on the front line and the patients who depend on them.”The doctors with the Center for Restorative Breast Surgery and St. Charles Surgical Hospital claimed Blue Cross tried to coerce them into their network, leading to a trial in both federal and state courts. After a three-week trial, the jury returned the verdict against Blue Cross and Blue Shield of Louisiana in less than two hours.“The jury’s finding of misconduct by Blue Cross and Blue Shield of Louisiana shows that the legal system will not allow Blue Cross and Blue Shield of Louisiana to put its self-interest ahead of that of its patients. Physicians and patients have a right to expect Blue Cross and Blue Shield of Louisiana to uphold their promise to provide fair and accurate payment for services,” said attorney Matthew Sherman with Chehardy Sherman Williams. Blue Cross said it plans to appeal. In a statement to WDSU, the company said: “While we appreciate and value the legal process, we strongly disagree with the jury’s verdict. We will quickly appeal and expect to be successful.”Our mission is to improve the health and lives of Louisianians. Part of that mission is to work with network providers to offer high-quality care at fair reimbursements, ensuring our members access to affordable, quality care.”Unfortunately, verdicts like this contribute to increasing healthcare costs for Louisianians who depend on us every day.”Jeff Drozda, the CEO of the Louisiana Association of Health Plans, echoes those sentiments. “Health plans will be forced to pay out-of-network non-negotiated providers. Bill charges. And that means whatever that they would like to charge,” said Drozda. “You will have other providers across the state regardless of what health plan it is. And they’re going to be looking at the opportunity to similar bill charges for claims reimbursement.”The doctors involved in the lawsuit said they plan to use the awarded money to pay off patients’ balances. They hope this sets a precedent for accountability moving forward.
A jury has awarded $421 million in damages to a group of Louisiana doctors after finding Blue Cross Blue Shield committed fraud and abuse of rights.
The insurance company was found to have withheld payments for approved procedures, including breast reconstruction following cancer treatment, at the Center for Restorative Breast Cancer.
“This landmark victory not only holds Blue Cross and Blue Shield of Louisiana accountable but also exposes a hidden problem in our system,” said Dr. Frank DellaCroce. “This has been very difficult, but we are pleased that the jury saw the truth. It is a victory for all those who have felt bullied by big corporate health insurance and the self-serving things they do to drain resources from care delivery. We work the long hours, we pioneer advancements, we take care of these women, and we fought back for those who work on the front line and the patients who depend on them.”
The doctors with the Center for Restorative Breast Surgery and St. Charles Surgical Hospital claimed Blue Cross tried to coerce them into their network, leading to a trial in both federal and state courts.
After a three-week trial, the jury returned the verdict against Blue Cross and Blue Shield of Louisiana in less than two hours.
“The jury’s finding of misconduct by Blue Cross and Blue Shield of Louisiana shows that the legal system will not allow Blue Cross and Blue Shield of Louisiana to put its self-interest ahead of that of its patients. Physicians and patients have a right to expect Blue Cross and Blue Shield of Louisiana to uphold their promise to provide fair and accurate payment for services,” said attorney Matthew Sherman with Chehardy Sherman Williams.
Blue Cross said it plans to appeal. In a statement to WDSU, the company said:
“While we appreciate and value the legal process, we strongly disagree with the jury’s verdict. We will quickly appeal and expect to be successful.
“Our mission is to improve the health and lives of Louisianians. Part of that mission is to work with network providers to offer high-quality care at fair reimbursements, ensuring our members access to affordable, quality care.
“Unfortunately, verdicts like this contribute to increasing healthcare costs for Louisianians who depend on us every day.“
Jeff Drozda, the CEO of the Louisiana Association of Health Plans, echoes those sentiments.
“Health plans will be forced to pay out-of-network non-negotiated providers. Bill charges. And that means whatever that they would like to charge,” said Drozda. “You will have other providers across the state regardless of what health plan it is. And they’re going to be looking at the opportunity to similar bill charges for claims reimbursement.”
The doctors involved in the lawsuit said they plan to use the awarded money to pay off patients’ balances. They hope this sets a precedent for accountability moving forward.
Clinton Mora is a reporter for Trending Insurance News. He has previously worked for the Forbes. As a contributor to Trending Insurance News, Clinton covers emerging a wide range of property and casualty insurance related stories.