Blue Cross Blue Shield Loses $421M Fraud Verdict Over Denied Payments

A recent $421 million fraud verdict against Blue Cross and Blue Shield of Louisiana cast a national spotlight on the controversial practice of prior authorizations. The case was brought by the Center for Restorative Breast Surgery in New Orleans, whose co-founders, Drs. Frank DellaCroce and Scott Sullivan, spent nearly two decades alleging that Blue Cross authorized medically necessary procedures but then denied or drastically underpaid claims - reimbursing less than 9 percent of billed charges across more than 7,800 procedures. Despite receiving prior authorization, patients and the surgical center were left covering the gap, often without any appeals being reviewed. Click here for more from ProPublica.