A Florida jury sides with American Clinical Solutions in a long-running reimbursement dispute with Blue Cross Blue Shield of Puerto Rico.
A Florida jury awarded American Clinical Solutions (ACS) approximately $6 million in damages following a decade-long legal battle with Blue Cross Blue Shield of Puerto Rico over unpaid claims for diagnostic laboratory services.
The verdict, delivered after an eight-day trial in the 15th Judicial Circuit in Florida, concluded litigation that began in 2015. ACS, a clinical diagnostic laboratory specializing in advanced testing for prescription narcotics, alleged that Blue Cross Blue Shield failed to pay for medically necessary diagnostic services ordered by in-network physicians based in Puerto Rico.
“We are pleased that the jury affirmed ACS’ position and recognized the value of the clinical testing we provided to Blue Cross Blue Shield of Puerto Rico members,” says ACS president Roger Brown in a statement to 24×7. “ACS endured more than 11 years of litigation to obtain this much-deserved verdict. Today’s outcome sends a critical message to the insurance industry: Laboratories that follow the rules deserve to be paid for the work they perform. We trust that all payers will take note.”
The case highlights ongoing tensions between clinical laboratories and health insurers over reimbursement for specialized diagnostic testing. Laboratory testing for prescription narcotics has become increasingly important as healthcare providers seek to monitor patients receiving pain management treatment and combat prescription drug abuse.
“This is an important victory in a decade-long battle against a health insurance giant,” says Raoul Cantero, who co-led the White & Case litigation team representing ACS, in a release. “The lesson is that these cases can be won with collaboration and teamwork on the trial team, and that juries will hold insurance companies accountable for ignoring claims made for lab testing designed to help patients with chronic pain.”
White & Case LLP represented ACS throughout the litigation. The $6 million judgment represents compensation for diagnostic services that ACS performed but for which Blue Cross Blue Shield of Puerto Rico allegedly failed to provide reimbursement over multiple years.
