$6.2 Million in BCBS Settlement Checks Delivering Soon to NC Physicians
June 29th, 2009
The final appeal in the class action lawsuit NCMS and other medical societies brought against the Blue Cross Blue Shield Association has been resolved, resulting in the distribution of the monetary settlement claims this summer. All North Carolina physicians who timely filed claim forms will receive a share of $6.2 million in settlement funds. The lawsuit alleged that BCBS had conspired to defraud physicians out of reimbursements owed in violation of federal anti-racketeering statutes and state laws.
The date for filing this claim form for was October 19, 2007. However, regardless of whether they filed for damages, all North Carolina physicians are benefiting from the business changes that BCBSNC was required to make under the Settlement Agreement. Among other commitments, BCBSNC:
- May not seek overpayment recovery beyond 18 months unless fraud or intentional misconduct is established
- Must provide 90 days advance notice of material adverse changes, including decreases in fees
- Must adhere to most CPT® coding rules
- Must rely on credible scientific evidence in formulating medical policies
- May not require participation in all its products
- May not require physicians to obtain written patient authorization to pursue payment appeals
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