"Health Care"

Health Care

CRA combines in-depth industry knowledge and cutting-edge analytics to evaluate issues being litigated and debated in the health care sector. Our industry knowledge enables us to explain, for example, the nuances of provider reimbursement or the patient incentives created by high deductible health insurance plans, and our economic, statistical, accounting, and finance skills—as well as our familiarity with key health care datasets—equips CRA to provide rigorous, defensible analyses tailored to the specific facts of a litigation or regulatory dispute.

Attempted monopolization

Capabilities
In the area of attempted monopolization, CRA and its experts:

  • Provide consultation and expert testimony in matters involving allegations of exclusive dealing, raising rivals’ costs, tying and bundling, most favored nations provisions and other contracts that reference rivals, monopsonistic reimbursement, entry exclusions through the Certificate of Need process, pay-for-delay, and price discrimination.
  • Use cutting-edge economic theory and empirical analysis to distinguish aggressive competition that is procompetitive from business practices that hinder competition.
  • Address questions related to merits, damages, and class certification.
  • Work with key health care data sources to develop original economic analyses tailored to the specific facts of each case.

Collusion and price fixing

Capabilities
In the area of collusion and price fixing, CRA and its experts:

  • Provide consultation and expert testimony in matters involving collusion and price fixing, including common MCO reimbursement practices, joint provider negotiations, group boycotts, reverse payments/pay-for-delay and agreements to allocate customers.
  • Utilize key health care data sources and sound economic theory, as well as econometric expertise, to assess the plausibility of collusion claims and to perform statistical analyses to distinguish between competitive and anti-competitive pricing and payment.
  • Address associated merits, causation, class certification, and damages questions.
  • Employ broad health care sector experience that includes hospitals, physicians, MCOs, PBMs, pharmacies, pharmaceuticals, clinical laboratories, dialysis services, ambulance transport, nursing homes, among other health industry segments to ensure that analyses reflect unique industry attributes and incentives.

Mergers

Capabilities
In the area of mergers, CRA and its experts:

  • Provide consultation and expert testimony analyzing the competitive effects of horizontal and vertical mergers and joint ventures across the health care sector, addressing the questions raised by the Horizontal Merger Guidelines and current enforcement practice.
  • Identify and account for the unique characteristics of the health care industry that shape competitors’ behaviors and incentives utilizing CRA’s broad and deep experience with all facets of the health care industry.
  • Utilize key health care data sources and rely on sound economic theory to define product and geographic markets, assess the competitive constraints of entry and expansion, and consider the impact of insurance and regulatory oversight on market dynamics.
  • Identify and quantify the cost reductions and quality enhancements that are significant and only achievable through the proposed merger.
  • Assess the long run financial viability and competitive significance of the merging parties absent the proposed merger.
  • Work with management to design joint ventures that combine operations in a manner that minimizes antitrust concerns.

Class Certification

Capabilities
In the area of class certification, CRA and its experts:

  • Provide consultation and/or expert testimony evaluating class certification issues, including commonality and typicality as well as assessment of class-wide damages and damage allocation models.
  • Analyze health care data (e.g., medical claims data from health plans, medical providers, or government sources) to demonstrate statistically whether or not the impact to members of a putative class can be assessed with a common framework or whether members of a putative class share common interests.
  • Apply health care knowledge, economic theory, and quantitative analysis to assess an existing class-wide damages model or propose an appropriate and supportable damages model.
  • Identify and account for the unique characteristics of the health care industry utilizing CRA’s broad and deep health care sector experience, including hospitals, physicians, MCOs, pharmaceuticals, dialysis services, clinical laboratories, ambulance transport, PBMs, nursing homes, and medical waste services.

Damages

Capabilities
In the area of damages, CRA and its experts:

  • Provide consultation and expert testimony in matters involving individual or class-wide damages in antitrust, fraud/false claims, reimbursement, product liability, patent/trademark/copyright, and commercial disputes.
  • Isolate and measure the harm of any alleged wrongful activity by constructing models of the “but-for” world that are well-founded and based on sound economic theory and empirical evidence utilizing key health care data sources.
  • Leverage CRA’s in-depth knowledge of all facets of the health care industry, as well as its economics, accounting, and statistical expertise, to evaluate allegations and damages claims and to design rigorous damages models tailored to the specific facts and circumstances of each case.
  • Assess issues related to disputes involving lost profits, breach of contract, purchase price, valuation, business interruption, product liability, and fraud, among other damages claims.
  • Provide pretrial evaluations of damage claims and methodologies, including proposed settlements.

Fraud and False Claims

Capabilities
In the area of fraud and false claims, CRA and its experts:

  • Provide consultation and expert testimony in fraud and False Claims Act matters involving promotion, marketing, pricing, reimbursement, and distribution policies.
  • Leverage CRA’s in-depth knowledge of the health care industry, as well as its economics and statistical expertise, to evaluate allegations including, among other things, kickbacks leading to medically inappropriate provision of goods and services, inappropriate referrals, deceptive marketing, up-coding, or fraudulent billing practices.
  • Design economic analyses tailored to the industry-specific facts and circumstances of each case and develop damages models that are grounded in robust methodologies and that reflect market realities.
  • Work with key health care data sources and rely on sound economic theory, as well as econometric expertise, to analyze class certification, merits, causation, and damages questions.
  • Utilize broad and deep experience of the health care sector including hospitals, physicians, health insurance, PBMs, pharmacies, pharmaceuticals, clinical laboratories, dialysis services, ambulance transport, and nursing homes.

Reimbursement

Capabilities
In the area of provider reimbursement, CRA and its experts:

  • Provide consultation and expert testimony in disputes relating to determination of appropriate payment amounts and allegations of inappropriate denial of claims, billing practices, and out-of-network payment policies.
  • Perform statistical analyses to distinguish between procompetitive and anticompetitive pricing and payment.
  • Leverage CRA’s in-depth knowledge of the health care industry, as well as its statistical and economics expertise, to evaluate allegations of inappropriate denial of claims, up-coding, or fraudulent billing practices.
  • Utilize statistical sampling to evaluate reimbursement allegations efficiently, including the assessment of whether there are systematic patterns in payments or claims.
  • Analyze Medicare, Medicaid, and managed care health care claims data, as well as other key health care data sources, and rely on sound economic theory to evaluate class certification, merits, and damages questions.
  • Utilize broad and deep experience with all facets of the health care industry.