CRA’s healthcare experts advise on dispute resolution and reimbursement compliance for health benefits companies, healthcare providers, and plan participants. Our team of experts has evaluated health plans’ compliance with regulations and plan requirements regarding payments to out-of-network providers, audited payments made under the terms of network agreements, and have determined the fair-market or reasonable value of healthcare services. We have also assessed whether consumers’ benefits were adjudicated consistently with the terms of their plans. CRA provides these services in connection with arbitrations, litigation (including class action matters), and regulatory reviews.
- 01Out-of-network provider reimbursement litigationCRA experts provided statistical and antitrust expertise to a health insurer involved in a class action lawsuit in which plaintiffs alleged that the insurer...View engagement
- 02Pharmaceutical pricing and reimbursement In re: Average Wholesale Price LitigationOur client, the Joint Defense Group (JDG), represented pharmaceutical manufacturer defendants in the AWP multidistrict litigation. The JDG had to educate the...View engagement
- 03Physician reimbursementPhysicians are sometimes accused of raising their payment demands to supracompetitive levels. Conversely, payors are sometimes alleged to use their market...View engagement