Payer-Provider Disputes
Strong economic expertise with standard-setting modeling in healthcare disputes
Bates White experts possess a deep and sophisticated understanding of the healthcare industry and the complex, interconnected relationships among industry stakeholders such as payers, providers, and state and federal regulators. Our knowledge of the ever-changing healthcare field, our nuanced understanding of how claims are aggregated and combined for purposes of litigation, and our proprietary databases of resources and learnings enable us to deliver effective, often innovative, and unexpected solutions and strategies that meet our clients’ unique needs. We have helped shape industry standards for healthcare provider competition analysis, including developing econometric modeling that antitrust agencies, courts, and academic experts have relied on. Our experts have an unusually comprehensive and pragmatic perspective on healthcare policy and competition, enabling us to offer tailored analysis and compelling expert testimony to support managed care organizations, health plans, payers, and providers.
Comprehensive expertise in numerous contexts and types of disputes
We have provided expert consulting and testimony in disputes brought under state and federal surprise billing laws, the Employee Retirement Income Security Act (ERISA), the False Claims Act (FCA), the Anti-Kickback Statute (AKS), Unfair Competition Laws (UCL), and antitrust statutes. Additionally, we have provided our expertise in litigation and arbitration involving reimbursement rate disputes; plan network issues; benefits and coverage disputes; Centers for Medicare and Medicaid Services Medicare Advantage bidding rules; out-of-network providers; and usual, customary, and reasonable rate assessments.
