Blue Cross and Blue Shield of Illinois has agreed to pay $25 million to settle civil claims that it wrongly denied medically fragile children private duty nursing care covered by their policies in order to shift them to Medicaid.
Illinois' Blues to pay $25 million in settlement
Under the agreement, the Illinois Blues will pay $14.25 million to the state of Illinois, and $9.5 million to the federal government. It will also pay $1.25 million to Illinois for allegations under the state consumer fraud statute. The insurer admits no liability or wrongdoing in the settlement.
The government alleged that not only did the Illinois Blues unlawfully deny benefits it owed to the families, but fraudulently told policyholders that the children were not covered for private duty nursing during claims reviews that were sought after initial denials. The alleged practices took place between 2000 and 2010.
“While we disagree with the allegations and deny any inappropriate conduct at any time, we are pleased to put this matter behind us and focus on serving the needs of our policyholders,” the Illinois Blues said in a statement.
Blue Cross and Blue Shield of Illinois is a subsidiary of Health Care Service Corp., a Chicago-based not-for-profit that operates Blues plans in four states.
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