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Sun May 17, 2020, 04:56 AM

Blue Cross Ordered to Pay $180 Million for Withholding Payments from Hospitals

An arbiter has ordered Richardson-based Blue Cross Blue Shield of Texas to pay $108.3 million in damages and attorneys fees to Little River Healthcare, which operated rural hospitals in central Texas until the facilities went bankrupt in 2018.

Via arbitration, former Supreme Court Justice Harriet ONeill ruled that BCBSTX breached contracts and did not meet the Texas Prompt Pay statutes. An exhibit in the case reads that BCBSTX owes over $65 million, among other amounts, because BCBSTX breached the contracts in issue by failing to pay for laboratory services provided to BCBSTX members, improperly recouping funds previously paid to Little River for provided services, and failing to timely and appropriately adjudicate the laboratory claims submitted by Little River.

Lawyers fees, interest, and other violations make up the rest of the money owed. BCBSTX shall take nothing on its counterclaims and is entitled to no damage award in its favor, the exhibit reads.

In 2018, Little River began legal demands against Blue Cross, including breach of contract, and Blue Cross responded with claims of its own, including fraud. Little River operated the only hospital in Milam County, a Critical Access Hospital, as well other hospitals, clinics, diagnostic and imaging centers, and a physician network.

Read more: https://www.dmagazine.com/healthcare-business/2020/05/blue-cross-ordered-to-pay-180-million-for-withholding-payments-from-hospitals/?ref=mpw

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