Michigan’s Blue Cross Blue Shield will face an antitrust lawsuit challenging reimbursement rates for local anesthesiologists, a federal judge in Detroit ruled last week, a year after the same judge dismissed the case.
Judge Terrence G. Berg ruled that the Ann Arbor Society of Anesthesiology could resubmit the original complaint with minor amendments against the Detroit-based insurance company, alleging that it had a scheme plans to pay anesthesiologists below market rates and collude with hospitals to prohibit anesthesiologists from charging more than the BCBSM reimbursement rate.
The judge dismissed a claim in the lawsuit alleging a conspiracy between the hospitals and BCBSM to maintain rates regardless of its impact on care.
Claims are underway accusing BCBSM of creating a monopoly by becoming the state’s largest insurer and manipulating market prices to the point of resulting in a massive exodus of doctors. anesthesia in the state and thus endanger the patient.
“We are pleased that the court has agreed with one of our positions on their litigation and we remain confident we will win as the case continues,” BCBSM said in a statement sent via email. email Crain.
The A4 is represented by Boies Schiller Flexner LLP of New York. The Boies Schiller Company is chaired by David Boies, who served as special counsel in the 1998 Microsoft antitrust case and represented former vice president Al Gore in the 2000 presidential tally in Florida.
“A4 is a dedicated team of anesthesiologists who have taken this action to stop the Blue Cross Blue Shield’s harsh and anti-competitive practices that are driving doctors out of Michigan and undermining quality.” amount of care available to Michigan patients,” lead attorney for the case Jonathon Schiller said in an emailed statement to Crain’s. “This is certainly an issue of great concern to Michigan patients, and we look forward to presenting our federal and state law complaints before a Detroit grand jury and demanding that BCBS-MI be subject to responsible for their actions.”
A4 is asking the court to stop the Blues from interfering with any of their contracts, stop efforts to restrict trade in violation of the Sherman Antitrust Act, and maintain monopoly power over anesthetic services. in Michigan.
A4’s attorneys are also asking the court to award an unspecified triple punitive damages for Blue Cross’ “crooked conduct” that would seek to destroy A4 financially by causing Trinity Health based in Livonia terminated its contract. The A4 has now returned to Trinity and works with a number of hospitals, including Trinity Health Ann Arbor Hospital, McLaren Lapeer Regional Hospital and Garden City Hospital.
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“Under this conspiracy, Michigan hospitals have agreed with BCBSM and each other, barring anesthesiologists from hospital facilities unless such physicians accept BCBSM’s uniform reimbursement rates, without any increase or decrease,” the lawsuit reads. “This conspiracy has restricted trade through group boycotts and other restrictive measures. BCBSM enforces these illegal boycotts and price-fixing agreements by moving away from any real estate agent. any hospital if the anesthesiologist there looks for a different rate than the BCBSM Because anesthesiologists require access to medical facilities to practice medicine, this conspiracy forces anesthesiologists must accept the published rate of BCBSM.”
The lawsuit alleges this has led to a shortage of anesthesiologists.
“Because Michigan anesthesiologists’ only option was to accept the BCBSM reimbursement rate or leave the state and practice elsewhere, many chose to leave (or not enter) the state, leaving Michigan. , as of April 2021, with nearly a hundred anesthetic positions unfilled.”, the suit reads. This shortage of anesthesiologists has reduced the supply of overall anesthesia services in Michigan to patients, as evidenced by the fact that hospitals have been forced to close their surgical departments because of a lack of qualified anesthesiologists for patients. Despite the wide variety of open positions for anesthesiologists in Michigan, the majority of University of Michigan anesthesiology graduates leave the state to work elsewhere, rather than work. jobs in Michigan for less than competitive BCBSM pay.”
It is not clear whether the hospitals closed their surgical departments to cause the shortage or whether the shortage was in fact caused by the incidence of BCBSM.
However, there is a national and state shortage of anesthesiologists, and Michigan became the 20th state earlier this year to allow certified registered anesthesiologists to work in the operating room without the need for anesthesiology. the supervision of an anesthesiologist. The new rule is a more permanent continuation of emergency executive orders signed by Governor Gretchen Whitmer during the pandemic to assist overflowing hospitals.
The A4 lawsuit stems from a breakdown in negotiations between the practice body and BCBSM in October 2020. A day after BCBSM refused to renegotiate with A4, Trinity Health Michigan CEO Rob Casalou has filed a lawsuit. invoked a clause in his five-year contract to terminate A4 in 180 days. After that period, Trinity said, the eight-hospital regional health system will hire anesthesiologists to do its own work.
The lawsuit alleges Trinity was manipulated by the BCBSM to terminate the contract.
The original lawsuit against BCBSM was announced by a judge last year due to a lack of evidence for prior valuation. The lawsuit alleges monopoly, which means consumers will have to pay higher prices. That’s not the case with a single unit, which reduces competition.
A4 has vehemently defended its operations in a number of disputes with hospitals and insurance companies over the years.
In 2019, a similar dispute broke out between A4 and Trinity Health, in which Trinity terminated A4’s contract. A4 has threatened to terminate several payer contracts, including Priority Health, Aetna and Blue Cross, because it has not had a reimbursement increase for at least six years.
Trinity Health sued to prevent A4 from placing its patients in a “surprise billing” situation. A4 has objected to preventing Trinity from employing its own anesthesiologists and certified registered nurse anesthetists. Trinity and A4 settled various lawsuits and reached a new five-year agreement. The agreement allows A4’s anesthesiologists to continue treating patients at Trinity Health’s five Southeast Michigan hospitals.
A4 also has a contractual dispute with eight hospitals Beaumont Health over the amount Beaumont reimburses A4 for anesthesia services. A4 argued that Beaumont had paid the team below operating expenses and that they were losing money every day. A4 terminated its contract with Beaumont in March 2020.
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