An association representing the ambulance and medical transportation industry in Pennsylvania has filed a federal lawsuit against the Blue Cross Blue Shield insurers in the state over practices they say cost them millions over the last four years.

The Ambulance Association of Pennsylvania (AAP) filed the suit in U.S. District Court for the Western District of Pennsylvania against Capital Blue Cross, Highmark, Hospital Service Association of Northeastern Pennsylvania, Independence Blue Cross, Keystone Health Plan Central and Keystone Health Plan West.

The suit, according to the association, alleges the Blues engaged in a pattern of racketeering activity “designed to extort, or attempt to extort,” non-contract ambulance providers to enter contracts with them at below-market rates they dictate.

The AAP claims that such practices have cost its members “millions of dollars in financial harm,” according to a statement.

The allegations against the Blues state that when non-contract ambulance companies provide emergency services to Blue enrollees, the providers submit claims for payment to the insurers, but the insurers “routinely” send payments to “unsuspecting enrollees who frequently do not understand why they are receiving payment and cash or otherwise dispose of the payments,” the AAP alleges.

The result of not sending payments to the ambulance companies has resulted in companies going unpaid, “losing millions over the last four years,” the group claims.

“The BCBS companies have regularly advised the non-contract ambulance companies that if they want direct pay, they should enter contracts with the BCBS Companies at sub-market prices or rates set by the insurers,” the AAP said in a statement.

The suit alleges violations of state law, including the Quality Health Care Accountability and Protection Act, and also constitutes a violation of the federal Racketeer Influenced and Corrupt Organizations (RICO) Act.

The suit, seeking a resolution and damages, was filed by the AAP with more than a dozen paramedic providers, including the City of Pittsburgh.

Capital Blue Cross and IBC told IFAwebnews.com the insurers do not comment on pending litigation and Highmark indicated it could not comment as it had not been served with the suit.