Highmark Inc. has agreed to a $10 million settlement with a doctors group that has alleged unfair business practices against the Pittsburgh health insurer and most other major insurers in the United States.

The total cost to Highmark could swell to $14 million or more once legal fees and other expenses are tallied.

The settlement was similar to, but not a part of, a $128 million settlement between 900,000 physicians nationwide and two dozen other Blue Cross and Blue Shield plans earlier this year.

The doctors have alleged in each Blues case -- and in similar cases against for-profit insurers such as Aetna and Cigna -- that the insurers have violated the Racketeer Influenced and Corrupt Organizations act, the federal statute more commonly known as RICO. The doctors say insurers have systematically denied and delayed payments and claims that are rightly owed to the doctors, or under-reimbursed the physicians.

Since the 1980s, plaintiffs have been invoking the anti-racketeering RICO act to sue insurers for fraud, over the objections of the insurers, which believed that the RICO act, as a federal law, shouldn't apply to organizations regulated at the state level.

But in 1999, the U.S. Supreme Court ruled insurance fraud claims may be tried via RICO.

Highmark denied wrongdoing, as did the other Blues outfits, but agreed to the settlement in October so both Highmark and the doctors' group could avoid further, costly litigation.

The United States District Court for the Southern District of Florida gave its preliminary approval to the settlement last week, then released its terms.

Highmark (and its West Virginia subsidiary, Mountain State Blue Cross and Blue Shield, which was included in the settlement, as well as other subsidiaries) will pay $9.96 million into a settlement fund, which will be distributed to doctors in varying amounts, including physicians who have retired in the eight years since the case initially was filed in Florida.

They also will pay as much as $3.81 million toward the doctors' legal fees, plus an additional $7,500 per class-action plaintiff.

"We had wanted to settle back when all the other Blue Cross Blue Shield plans did, but there was some other litigation that was pending that prevented us from doing so," said Highmark spokesman Michael Weinstein.

The settlement requires Highmark, like the other Blues, to improve its claims processing and provide better methods for arbitrating disputes between the insurer and its doctors.

A follow-up hearing is scheduled for Jan. 31, when the court will consider some outstanding issues, and decide whether the settlement will win formal approval.