Humana must face claims it interfered with doctors’ contracts in antitrust case

Signage for Humana Inc. is pictured at a health facility in Queens, New York City, U.S., November 30, 2021. REUTERS/Andrew Kelly

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  • Fraud claims against Blue Cross and Blue Shield of Louisiana and claims reviewer AllMed Healthcare Management time-barred
  • Judge allowed an allergy service’s claims of interference against insurer Humana to proceed

(Reuters) – Blue Cross and Blue Shield of Louisiana and claims reviewer AllMed Healthcare Management have escaped a fraud claim accusing them of lying to allergy testing company United Allergy Services (UAS) and an association of allergy and asthma doctors as part of a scheme to deny them coverage.

U.S. District Judge Carl Barbier in New Orleans ruled Monday that the fraud claims were barred by Louisiana’s statute of limitations. He allowed a claim accusing insurer Humana Inc of interfering with UAS’s contracts with doctors, to proceed.

Barbier’s ruling comes as part of a broader lawsuit by UAS and the Academy of Allergy & Asthma in Primary Care (AAAPC) accusing Humana, AllMed and Blue Cross insurers of both Louisiana and Kansas of conspiring to drive UAS out of the market by agreeing with one another not to cover its services. The ruling does not affect claims in the case, which is set to go to trial next year, accusing all the defendants of violating federal antitrust law.

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Michael Drew of Jones Walker, a lawyer for Louisiana Blue Cross and AllMed, declined to comment. Lawyers for the plaintiffs, Kansas Blue Cross and Humana did not immediately respond to requests for comment.

UAS contracts with doctors to provide allergy testing and immunotherapy, in which patients receive injections with gradually increasing doses of allergens to desensitize them.

UAS and AAAPC, which represents doctors who treat allergies, said in their January 2018 lawsuit that beginning around 2013, the insurers noticed an increase in allergy treatment claims and began working together with AllMed to avoid paying for UAS’s services.

They said that the Blue Cross companies began refusing to cover the treatments as not medically necessary, and that AllMed upheld those determinations on review. They also said Humana encouraged doctors in multiple states to terminate their contracts with UAS.

The plaintiffs brought a fraud claim against Blue Cross of Louisiana and AllMed, saying they made misrepresentations about their reasons for denying claims. They brought a tortious interference with contract claim against Humana.

The defendants sought summary judgment on statute of limitations grounds. Barbier said the fraud claims were governed by Louisiana’s statute of limitations, which was only one year, and thus barred, but that the tortious interference claims were subject to the two-year statute of limitations in Texas, where UAS is based.

He thus ruled that contract claims arising after January 2016 could proceed.

The case is Academy of Allergy & Asthma in Primary Care v. Louisiana Health Service and Indemnity Co, U.S. District Court for the Eastern District of Louisiana, No. 2:18-cv-00399.

For AAAPC: Casey Low of Pillsbury Winthrop Shaw Pittman

For Blue Cross and Blue Shield Louisiana and AllMed: Michael Drew of Jones Walker

For Blue Cross and Blue Shield of Kansas: Dan Hofmeister of Reed Smith

For Humana: Shari Ross Lahlou of Dechert

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Our Standards: The Thomson Reuters Trust Principles.

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