Illinois Blue Cross Blue Shield Will Pay $25M to Settle Allegations of Denying Children Coverage, Shifting Costs to Medicaid

Blue Cross Blue Shield Illinois, the state's largest health insurance company, will pay $25 million to settle allegations that it denied coverage to sick children by shifting their expensive claims to the state's Medicaid program, according to a news release from Illinois Attorney General Lisa Madigan.

Attorney General Madigan and U.S. Attorney Patrick Fitzgerald alleged BCBS denied patient claims based on internal, undisclosed guidelines that were more restrictive than the language in plan policy materials indicated. As a result of the denials of claims for in-home, skilled nursing care or complex medical needs, BCBS allegedly shifted nearly $12 million in costs to the state and federal Medicaid program.

Under the settlement, BCBS will pay $14.25 million to Illinois and $9.5 million to the U.S. Treasury to help fund and reimburse Medicaid programs. It will also pay $1.25 million to Illinois consumers who were denied claims by BCBS but did not receive Medicaid coverage.

Read the release on Illinois Blue Cross Blue Shield.

Read about other recent settlements from healthcare companies:

- New York's APS Healthcare Pays $13M to Settle False Claim Allegations

- 5 Pharmaceutical Drugmakers Pay North Carolina $25M for Off-Label Marketing, Kickbacks