Essay - Blue Cross Blue Shield is an Association of 42 Independent...

Blue Cross Blue shield is an association of 42 independent, locally operated health pl*****s. As such, each health plan in the organization is a priv*****te *****surer that *****fers coverage to mostly corporate employees. Collectively, they cover 81.5 million people in the US and Canada, and Represent 28.6 percent of the ***** population. Through membership in the association, the independent insurers (which formulate *****ir own strategies) are able to offer health plans that can be taken to other ********** of the country by pooling the medical professionals that ********** do business with. In addition ***** private companies, Blue Cross Blue Shield has partnered with the US Government to offer Medicare services. ***** 1939 the Blue ***** symbol was officially adopted ***** a commission of the American Hospital Association (AHA) as the national emblem for plans that met certain guidelines. ***** Cross and Blue Shield insurance companies were set up as community sponsored, non-profit service ***** that were based on contracts with hospitals and subscri*****rs. Most of ********** general voluntary plans accept subscribers in groups and as individuals. As *****, Blue ***** Blue Shield is the st*****ard bearer for the medical ***** industry rather than its strategist.

The Blue Cross and Blue ***** Plans occupy a unique niche: they *****re both sellers of ***** insurance and buyers of health *****. Because companies party to these plans ***** innova*****rs, they were able to develop a domin*****nt market share in most geographic areas. Many experts, as a result, believe that they receive favorable tax treatment, which includes ***** ***** status ***** tax exemption.

Blue Cross and Blue Shield's strategic ***** are often political ones, as the organization represents the interests of their 42 independent health plans. The ***** plans share vested ***** in the same political action, ***** dictates ***** policies they wish the ***** to implement. In ***** past, Blue Cross ***** Blue Shield has absorbed most of the operational aspects of Medicare. This strategy has been plagued by mismanagement and fraud. It is estimated that $100 billion a year is lost to health care fraud and abuse. Harvard University's Malcolm Sparrow estimates ***** figure to be even higher: $300 billion to $400 billion a year.

Cases cited include one in 1993, where ***** *****/***** Shield of Florida paid $10 ***** to settle out ***** court when charges ***** brought aga*****st it alleging that the company had falsified performance reports and failed to properly screen provider claims.

A similar case was brought against Blue Cross/Blue Shield of Massachusetts, which also chose ***** ***** out ***** court on charges that it falsified performance reports. Blue Cross/Blue Shied of Michigan and Blue Shield ***** California made similar settlements. ***** Michigan, Blue Cross/Blue ***** was accused of falsifying audit reports and using Medicare m*****ey to pay ***** that were ***** responsibility of other *****. *****'s Blue Cross/***** shield was accused ***** falsifying or destroying claims. The former settled for 51.6 million, while the later settled for a mere 12 million.

***** largest case was ***** of