Out-of-network provider reimbursement litigation

Out-of-network provider reimbursement litigation

Monica Noether
Health Care
Antitrust & Competition

CRA experts provided statistical and antitrust expertise to a health insurer involved in a class action lawsuit in which plaintiffs alleged that the insurer underpaid claims for out-of-network services. CRA experts filed class certification, merits, and damages reports that demonstrated that allegations of class-wide underpayment were inconsistent with statistical analyses of millions of claims spanning numerous data systems, antitrust harm was economically implausible, and damages estimates were overstated by billions. The plaintiffs’ motion for class certification was ultimately denied by a federal court.

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