DOJ Files Antitrust Suit Against BCBS Michigan

John Commins, for HealthLeaders Media , October 19, 2010

The Department of Justice filed a civil antitrust lawsuit Monday against Blue Cross Blue Shield of Michigan, alleging that the insurer's most favored nation pacts with hospitals across the state raise prices, stifle competition from other insurers, and discourage discounts.


As a result of these MFN pacts, Michigan consumers pay higher prices for healthcare services and health insurance, said Christine Varney, assistant attorney general in charge of DOJ's Antitrust Division.

"Any time a dominant provider uses anticompetitive agreements, the market suffers. This cannot be allowed in Michigan. And, let me be clear, we will challenge similar anticompetitive behavior anywhere else in the United States," Varney said.

Andrew Hetzel, BCBSM vice president for corporate communications, said the suit is "without merit" and that the insurer would "vigorously defend our ability to negotiate the deepest possible discounts for our members and customers with Michigan hospitals."

"Negotiated hospital discounts are a tool that Blue Cross uses to protect the affordability of health insurance for millions of Michiganders. Through this lawsuit, the federal government seeks to deny millions of Michigan residents the lowest cost possible when they visit the hospital," Hetzel said.

DOJ's complaint focuses on the MFN clauses that guarantee that other health plans cannot get a better rate. DOJ alleges that BCBSM's MFN clauses with hospitals have caused hospitals to increase their prices to BCBSM's competitors and insulated BCBSM from competition. BCBSM has used MFNs or similar clauses in its contracts with at least 70 of Michigan's 131 general acute care hospitals, including major hospitals, the DOJ complaint alleges.

DOJ said the MFNs require a hospital either to charge BCBSM no more than it charges the insurer's competitors, or to charge the competitors a specified percentage more than it charges BCBSM, in some cases between 30% and 40%. The complaint further alleges that BCBSM's use of MFN has reduced competition in the sale of health insurance in Michigan by raising hospital costs to BCBSM's competitors, which discourages other insurers from entering or expanding in Michigan.

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2 comments on "DOJ Files Antitrust Suit Against BCBS Michigan"

Todd (10/21/2010 at 12:20 PM)
I find it absolutely absurd that the Federal Government can justify a lawsuit like this when Medicare and Medicaid reimburse hospitals significantly below even the COST OF CARE! Talk about an MFN! Talk about the pot calling the kettle black!

mjh (10/19/2010 at 9:30 AM)
As a Michigander who has been round and round with BCBSM, the Michigan Office of Insurance and Regulation as well as my small business employer and some of our state reps, I say it's about time and thank you! However, what bothers me even more, and what is not addressed, is that if I am employed and my work offers insurance (any plan, no matter how expensive it is), I have to get insurance through my employer – even though I could save a lot of money buying it individually. Due to certain arrangements between the State of MI and BCBSM, buying insurance on your own is not possible – they also prevent other providers such as Priority Health from allowing individual policies. So, I cannot get an HSA no matter how hard I try without changing jobs. I also pay many thousands of dollars more per year for insurance that I don't use, and I have to pick my doctor from a list. I hate this system. You want competitive pricing? Make people shop for their own insurance and allow the insurance companies to actually compete.




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