Low Pay to Docs Results in Fine For Empire BCBS

Sins of a health plan’s past are not easily forgiven or forgotten, and often, in our litigious society, can mean costly retribution.

Empire Blue Cross Blue Shield is finding that out, thanks to a ruling by a federal judge that says the health plan must pay $21.6 million to some 52,000 subscribers because the plan set artificially low payment schedules for physicians between 1989 and 1995. The court found that this ultimately resulted in patients paying the difference.

Lawyers for six New York plaintiffs found that Empire appeared to have deliberately shaved the usual and customary rate (UCR) for physicians, which is often the basis for health plan fee arrangements.

“This is an old case that predates the current management at Empire,” Deb Bohren, an Empire representative, told Newsday. “The calculation of UCR was subject to a very complex process that is no longer being used at Empire and has not been since 1995.”

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