A Fox Rothschild health care litigation team led by Marcus C. Hewitt, Elizabeth Sims Hedrick and Robert Edmunds secured an important victory for the North Carolina State Health Plan that upholds its selection of Aetna as its third-party administrator.
An administrative law judge issued a 72-page decision that rejected claims by Blue Cross and Blue Shield of North Carolina alleging that the process of awarding the contract to Aetna was unfair. BCBSNC, which has administered the plan for more than 40 years, has announced that it will not appeal the ruling.
ALJ Melissa Owens Lassiter held a nine-day hearing in February and took testimony from 17 witnesses. In her decision, she agreed with the Fox team and held that the procurement was done “carefully and thoughtfully, fairly and in good faith, and that its decisions were properly within its discretion.”
The ruling capped more than a year of hard-fought litigation over a $300 million contract to administer about $3 billion in annual medical claims for teachers and state employees.
Lead attorney Marcus Hewitt said: “Despite Blue Cross’s disagreement with the contract decision, we’re gratified that the ALJ recognized that the process of evaluating proposals and awarding the contract was fair and proper at every step. We’re also grateful that no appeal will be taken and this protracted litigation is over because it’s the best result for the Plan’s members and North Carolina taxpayers.”
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