Bristow Endeavor Healthcare — the operator of three medical facilities in Oklahoma, including 30-bed Bristow (Okla.) Medical Center — has filed a lawsuit against the Blue Cross and Blue Shield Association, accusing the health insurer of conspiring with rivals to steer patients away from its facilities.
Here are eight things to know about the lawsuit.
1. In its lawsuit, Bristow Endeavor Healthcare claims BCBS colluded with competitors to keep Bristow's Center for Orthopaedic Reconstruction & Excellence in Jenks, Okla., out of network.
2. Bristow Endeavor Healthcare alleges Tulsa, Okla.-based Hillcrest Healthcare System and Nashville, Tenn.-based Ardent Health Services plotted with BCBS to exclude CORE from the Northeast Oklahoma/Tulsa area healthcare marketplace.
3. Hillcrest and Ardent — whose subsidiaries own and operate acute care health systems in three service areas, including Tulsa — allegedly told representatives of Tulsa (Okla.) Spine & Specialty Hospital, which is owned by Hillcrest, that an agreement had been reached for BCBS to reimburse Hillcrest for in-network services at rates well above current Medicare rates. In turn, BCBS allegedly said it would reimburse Bristow Medical Center for in-network services at rates below those offered to Hillcrest, according to the lawsuit.
4. BCBS also allegedly had discussions with Hillcrest about ways to prevent CORE from becoming an in-network provider with BCBS. During one of these discussions, Eddie Gwock, vice president of managed care services at Ardent, told representatives of Tulsa Spine that he could leverage his relationship with BCBS to keep CORE out of network.
5. BCBS has kept CORE out of network.
6. "Effectively, Blue Cross Blue Shield, Ardent Health Services, and The Hillcrest Healthcare System colluded and conspired in refusing to add CORE to Blue Cross Blue Shield's network," states the complaint.
7. Bristow claims the agreement between BCBS and Hillcrest was made with the intent for Hillcrest to maintain and eventually earn a higher percentage of the healthcare market share in the Northeast Oklahoma/Tulsa area.
8. As a result of the alleged conspiracy, Bristow Endeavor Healthcare claims CORE has been deprived of patient referrals from credentialed providers and the dollars that would have been associated with the care of those patients. Bristow claims it has incurred $40 million in damages, including lost profits, as a result of the "illegal and tortious conduct."
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