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BCBS of Michigan Gets Partial Win Over Tribal Medicare Discounts

Aug. 4, 2022, 3:24 PM

Blue Cross Blue Shield of Michigan defeated claims that it overcharged an American Indian tribe for health care after a federal judge said the tribe’s legal theory is premised on Medicare regulations that don’t explicitly govern the benefit administrator’s conduct.

The regulations Blue Cross is accused of violating require Medicare-participating hospitals to accept certain discounted payments—called Medicare-Like Rates—for services authorized by certain tribal organizations. These regulations don’t specifically reference third-party health plan administrators (TPAs) like Blue Cross and thus can’t form the basis of a claim accusing the company of violating the Michigan Health Care False Claims Act by failing ...