Healthcare News & Insights

Blue Cross pays hefty fine over denied care for sick kids

Blue Cross has agreed to pay $25 million to settle allegations that it wrongly denied coverage to sick children.

The charges were brought by the state of Illinois, which claimed the insurer fraudulently dumped the childrens’ claims to the state’s Medicaid program.

Prosecutors said the claims were denied based on the company’s own undisclosed guidelines which were more restrictive than the policy’s described in the material given to patients. Covering the childrens’ care cost the state about $12 million.

Blue Cross will pay $14.25 million to the state of Illinois, and another $9.5 million to reimburse Medicaid program. The remaining $1.25 million will be distributed among Illinois consumers denied coverage by Illinois Blue Cross who also did not receive Medicaid coverage.

Blue Cross denies any inappropriate business conduct in the matter.

Subscribe Today

Get the latest and greatest healthcare news and insights delivered to your inbox.