Bates White has extensive experience in litigation and other disputes involving managed care organizations and products. Our experts have a sophisticated understanding of the healthcare industry and the interconnected relationships between managed care organizations and other industry stakeholders—including providers, state regulators and administrative processes, and federal agencies.
With our in-depth industry knowledge and complete familiarity with healthcare databases, we provide insights that help inform our clients’ legal strategies by resolving uncertainties, helping them to make better decisions.
Our experience includes expert consulting and testimony on managed care disputes in the context of Employee Retirement Income Security Act (ERISA), False Claims Act (FCA), Anti-Kickback Statute (AKS), Unfair Competition Laws (UCL), Qui tam, and antitrust and other statutes. Areas of focus include:
- Benefits, contract, and coverage disputes
- Payer-provider contracting and reimbursement disputes
- CMS Medicare Advantage bidding and payment rules
- Pricing, billing, and reimbursement analysis
- Class certification and damages analysis
- Antitrust litigation
- Reimbursement disputes—Provided expert economic analysis and testimony in a litigation between MCOs and providers involving reimbursement rates and healthcare prices.
- Coverage disputes—Provided consulting and expert analysis on class certification and sampling issues on behalf of a health plan defendant in a litigation involving coverage disputes related to medical necessity criteria for behavioral health disorders in alleged violation of ERISA.
- Antitrust litigation—Provided consulting and expert analysis on behalf of a joint defense group of leading health insurers facing allegations of antitrust violations through improper denial of coverage.
- Class certification—Provided consulting and expert services on issues related to class certification and damages methodology with respect to pharmaceutical pricing and rebates in alleged violation of ERISA.
- False Claims Act—Provided expert analysis in connection with alleged FCA violations concerning Medicare Advantage bidding rules and gain/loss bid margins.