News & Events
Class Action Filed Against Blue Shield of California Challenging Plan's "Blue Ribbon" Physician Rating Program
9/16/2010
Related Attorney: Karen R. Palmersheim
Related Practice: Health Care
The California Medical Association (CMA) and two physicians (Plaintiffs) filed a class action lawsuit against Blue Shield of California (Blue Shield) on September 9, 2010, challenging Blue Shield's "Blue Ribbon" physician rating program. Among other allegations, Plaintiffs claim that the program is based on flawed methodology that economically profiles physicians, in violation of California Health and Safety Code section 1367.02(d). Plaintiffs seek an injunction enjoining Blue Shield from using its Blue Ribbon Recognition Program. Plaintiffs also seek damages, disgorgement of Blue Shield's gains related to the Blue Ribbon program, and attorneys' fees. The lawsuit (Complaint) was filed in the Superior Court in the State of California, County of Alameda, by the following law firms: Kiesel Boucher Larson LLP (Beverly Hills), Whatley Drake & Kallas LLC (New York and Alabama), The Consumer Law Group (San Diego), and Deblase Brown Eyerly LLP (Los Angeles).
The Complaint alleges that the Blue Shield Blue Ribbon Recognition Program violates the law by using an invalid ratings system to identify physicians who, according to Blue Shield, provide superior medical care. The Complaint alleges that the Blue Ribbon Recognition Program rating methodology is, in reality, an economic profiling scheme that inaccurately and unfairly "rates" physicians. The Complaint points out that while United Healthcare and Anthem Blue Cross of California opted to not publish ratings developed using the same methodology, Blue Shield published the ratings on its website on June 1, 2010.
Physicians Lisa Asta and Richard Stern seek relief for themselves and on behalf of the physician class comprised of California physicians who have an active provider contract with Blue Shield of California and are, or could have been, listed as a network physician on the website of Blue Shield of California. CMA seeks to recover relief for its members and itself, alleging CMA sustained damages for having lost personnel time and monetary resources in addressing the program issues.
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