Blue Cross Blue Shield cannot obtain summary disposition of case claiming it was guilty of fraud
In a recent holding by the Court of Appeals, the trial court's grant of summary disposition to Blue Cross Blue Shield was reversed, and the case, entitled Sault Ste. Marie Tribe of Chippewa Indians v. Blue Cross Blue Shield of MI, was reinstated. The Tribe sued the health insurer, claiming that the insurer made specific false representations about discounts and savings the tribe would achieve by contracting with BCBS to administer it's self-insured health plan. The insurer represented that it would give the tribe a 45.2% discount, rather than the 28.1% discount the prior administrator was charging, resulting in savings of $12 million dollars over five years.
The Tribe claimed the representations were false and that BCBS knew or should have known that they were not true. The judge had granted summary disposition, treating the promised inducements as sort of "puffing" or merely a promise of future efforts that is not actionable. The higher court concluded that there was a genuine question of fact with regard to whether the repeated claims were false statements of fact, recklessly or intentionally made with knowledge that they would reasonably be relied upon by Tribe administrators.