Provider reimbursement litigation

Provider reimbursement litigation

Sean May
Health Care
Antitrust & Competition

CRA was retained by a health insurer that was accused of conspiring with other payors to pay subcompetitive reimbursement rates to out of network physicians. Plaintiff provider and patient classes alleged that several payors all contributed faulty data to and then utilized a systematically flawed data base to determine their payment rates. Our class certification, merits, and damages analyses demonstrated that class-wide harm was contradicted by statistical analyses of millions of claims spanning numerous data systems, antitrust claims were economically implausible and unsupported by the facts, and damages estimates were overstated by billions. The plaintiffs’ motion for class certification was ultimately denied by a federal court.