Blue Cross Blue Shield

The Ninth Circuit affirmed two district court judgments dismissing ERISA actions brought by health care providers in DB Healthcare v. Blue Cross Blue Shield of Arizona, No. 14-16518, and Advanced Women’s Health Center v. Anthem Blue Cross Life & Health Insurance Co., No. 14-16612.  The health care providers’ argument was two-fold:  (1) health care providers were “beneficiaries” under Section 502(a) of ERISA, and thus could bring suit directly under ERISA; and (2) the plaintiffs in these cases could bring derivative claims under ERISA because the subscribers had assigned their claims under the plans to the plaintiffs.  The Court denied both these claims.
Continue Reading Ninth Circuit Denies Health Care Providers’ ERISA Claims

We often forget that state AG’s have jurisdiction under the HIPAA Omnibus Rule to levy fines and penalties against HIPAA covered entities for violations. This is because the Office for Civil Rights has traditionally taken the primary role in enforcing HIPAA. But Horizon Blue Cross Blue Shield of New Jersey (Horizon) was reminded of the AG’s ability to enforce HIPAA when it recently agreed to pay a $1.1 million fine to the New Jersey Division of Consumer Affairs for an incident that occurred in November of 2013  involving the theft of two unencrypted laptops from its offices.
Continue Reading Horizon BCBS of New Jersey Pays State $1.1 million for HIPAA violations