Health Care Litigation
In the complex health care delivery system in this country, disputes arise in many contexts. Health care providers challenge payors' claims adjudication policies and practices and payment amounts. Health insurance beneficiaries and health care providers dispute coverage decisions by payors. The drug pricing and/or marketing practices of pharmaceutical companies and pharmacy benefit managers (PBMs) lead to claims by payors. The complex regulatory environment that impacts our health care system also results in challenges that include issues related to the FDA, Hatch-Waxman Act, Medicare, Medicaid, ERISA, COBRA and claims of conspiracy, antitrust violations, false or deceptive trade practices, federal or state false claims act violations, workers compensation and other state law violations, and litigation or regulatory enforcement action by federal and state agencies.
Our Experience
Types of Claims
Our Health Care lawyers handle litigation, investigations, and arbitration throughout the country in virtually all areas including,
- Disputes regarding claims adjudication policies and practices and claims payment.
- Disputes regarding pharmacy claims submission requirements, coverage determination, and claims payment.
- Disputes relating to Medicare Advantage and Medicare Part D prescription drug benefit plans, including compliance actions.
- Disputes between beneficiaries and providers related to coverage determinations.
- Disputes relating to pharmaceutical drug pricing and drug promotion.
- Disputes relating to claims payment administration and repricing of claims, in the contexts of commercial health plans, rental networks, and workers compensation.
- Disputes with Regulatory authorities regarding compliance with statutory and administrative requirements.
- Disputes regarding anti-kickback violations and other federal and state regulation deficiencies.
- Misappropriation of Trade Secrets and Unfair Competition.
- Disputes relating to the development and production of medical devices.
Selected Results*
- Representation of defendants UnitedHealth Group, Inc. and PacifiCare, Inc. in an antitrust lawsuit involving alleged price-fixing and fraud relating to prescription drug reimbursement under the federal Medicare Part D program. Plaintiff Omnicare sought damages exceeding $1 billion and permanent injunctive relief. After lengthy discovery and numerous pretrial motions, we obtained summary judgment in favor of our clients on all claims on January 16, 2009.
Omnicare, Inc. v. UnitedHealth Group, Inc., 594 F. Supp. 2d 945 (N.D. III. 2009) (Appeal Pending)
- Representation of Blues plans and other health insurers in litigation against drug manufacturer for overpayments made for the prescription drug Paxil and Paxil CR. After lengthy discovery and numerous pretrial motions on claims which included allegations of antitrust violations arising from manufacturers' use of patents to keep generics out of the market, settlement obtained in the fall of 2008.
Blue Cross Blue Shield of Minnesota, American Medical Security Life Insurance Company, Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Nebraska, Carefirst, Inc., Blue Cross Blue Shield of Delaware, Inc., Excellus Health Plan, Inc., Hawaii Medical Service Association, Health Care Services Corporation, Horizon Health Care Services, Inc., Humana Inc., Louisiana Health Service & Indemnity Company, Medical Mutual of Ohio, Mutual of Omaha Insurance Company, Oxford Health Plans, LLC, Wellmark, Inc., The Regence Group, Time Insurance Company, Union Security Insurance Company,
John Alden Life Insurance Company v. Glaxosmithkline plc, et al.
- Representation of Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Minnesota, and Federated Mutual Insurance Company in litigation before the federal District Court in the District of Columbia involving claims of state antitrust law violations regarding competitors' access to raw materials for Lorazepam and Clorazepate. The jury's verdict found that Mylan Laboratories Inc./Mylan Pharmaceuticals Inc., Cambrex Corporation, and Gyma Laboratories violated state antitrust laws and had restrained trade and acted willfully in excluding generic competitors' access. In post-trial motions, the District Court awarded Plaintiffs treble damages, for a total award to all plaintiffs of $76.8 million. The parties are currently awaiting the Court's order on prejudgment interest.
In re: Lorazepam and Clorazepate Antitrust Litigation
- Defended eight ERISA plan sponsors and medical insurers (including Blue Cross plans) in an antitrust action by an out-of-program mental health care provider claiming that a wide ranging conspiracy existed among scores of insurers, plan administrators and plan sponsors to establish agreed compensation standards which foreclosed competition from non-PPO providers. Our clients and most of the complaint were dismissed, which was upheld on appeal to the Ninth Circuit.
Stephen Simon v. Value Behavioral Health (United States District Court for the Central District of California, civil action SA-CV96-0711 GLT (EEx))
- Representation of Blue Cross Blue Shield of Massachusetts as class representative and prevailing plaintiff in consumer fraud class action against manufacturers of various physician-administered medications.
In re: Pharmaceutical Industry Average Wholesale Price Litigation
- Representation of Blues plans and other health insurers in litigation against drug manufacturers for overpayments made for the prescription drug BuSpar. On claims which included allegations of antitrust violations arising from manufacturers' use of patents to keep generics out of the market, we obtained settlement for our clients.
Anthem Blue Cross Blue Shield, Blue Cross and Blue Shield of Florida, Inc., Blue Cross and Blue Shield of Louisiana, Blue Cross and Blue Shield of Massachusetts, Blue Cross Blue Shield of Michigan, Blue Cross Blue Shield of Minnesota, Blue Cross Blue Shield of Nebraska, Blue Cross Blue Shield of Oklahoma, Blue Cross Blue Shield of Tennessee, Blue Shield of California, CareFirst, Inc., Excellus Health Plan, Inc., The Guardian Life Insurance Company of America, Hawaii Medical Service Association, Health Care Service Corporation, Horizon Blue Cross Blue Shield of New Jersey, Humana, Inc., Mutual of Omaha, Regence Blue Shield of Idaho, Wellchoice, Inc., Wellmark, Inc. v. Bristol-Myers Squibb, et al.
- Representation of Blue CrossBlue Shield of Minnesota in class action lawsuits filed on behalf of participants seeking to claim over $400 million recovered in a prior settlement with the tobacco companies. A settlement was finally approved in which Blue Cross contributed an additional $11 million to afund previously established for participants, leaving most of the tobacco settlement for programs needed in Minnesota to address health issues.
Tow Distributing Inc., et al. v. Blue Cross Blue Shield of Minnesota, Inc.
- Representation of Blues plans and other health insurers in claims against drug manufacturers for overpayments made for the prescription drug Taxol.
- Defended $2 million claim against nursing registry for misappropriation of trade secrets to a verdict of $494.03, and obtained grant of nonsuit for individual defendant.
- Representation of Coventry Health Care, Inc., in multidistrict litigation brought by a nationwide class of physicians against 10 managed health care companies alleging that the companies conspired to program their computerized claims payment systems to improperly deny, diminish, or delay payments to physicians. After extensive motion practice eliminated all of the claims except RICO conspiracy to defraud and aiding and abetting, the District Court granted Coventry's motion for summary judgment on those surviving claims. The Eleventh Circuit affirmed the judgment on appeal. (Prior to joining Robins, Kaplan, Miller & Ciresi L.L.P.)
In re Managed Care Litigation MDL; Shane v. Humana, Inc., et al. - Representation of Coventry Health Care subsidiaries in two companion tag-along cases to the Managed Care Litigation MDL, brought by physicians in Kansas and Missouri, containing allegations against managed care companies that were similar to the allegations in the lead Shane case in the MDL. After denying the plaintiffs' motions to remand the cases to state court, the district court granted the defendants' motions to dismiss the cases without prejudice. The plaintiffs then filed new complaints, this time alleging breach of contract, again on behalf of statewide classes of providers. Once again the district court dismissed the cases without prejudice, requiring, as a condition for refiling the cases, that the plaintiffs exhaust their administrative remedies under ERISA.
Blue Springs Internal Medicine, P.C., et al. v. Blue Cross and Blue Shield of Kansas City, et al.
Mirabile v. Blue Cross and Blue Shield of Kansas City, et al. - Representation of Coventry Health Care of Iowa, Inc., in arbitration of payment disputes between Coventry and a hospital system. The case settled following discovery. (Prior to joining Robins, Kaplan, Miller & Ciresi L.L.P.)Mercy Medical Center - Des Moines v. Coventry Health Care of Iowa, Inc.
- Representation of First Health Group Corp., a subsidiary of Coventry Health Care, Inc., in arbitration with workers compensation insurance carrier relating to the repricing and adjudication of workers compensation insurance claims by First Health and payment by the insurer for First Health's services. The case settled after mediation before discovery on terms that were favorable to First Health. (Prior to joining Robins, Kaplan, Miller & Ciresi L.L.P.)
Patriot Risk Management, Inc. v. First Health Group Corp. - Representation of Coventry Health Care, Inc., in arbitration with nationwide provider of pharmacy services relating to dispute over submission, adjudication, and payment of claims for prescription drugs under the Medicare Part D prescription drug program. The arbitrator found in favor of Coventry as to some claims and in favor of the claimant as to some claims. The award was confirmed on appeal to the Superior Court in California.
Omnicare, Inc. v. Coventry Health Care, Inc. - Representation of Coventry Health Care of Georgia, Inc., in action by terminated employee alleging entitlement to health insurance continuation coverage benefits under COBRA. Coventry's motion for summary judgment on the ground that the small employer exception to COBRA applied was granted.
Rogers v. I D Design, Inc., et al. - Representation of Coventry Health Care, Inc., in purported nationwide class action by health care provider alleging a systematic breach of contract in the repricing and adjudication of workers compensation submitted by participants in Coventry's provider network. Upon Coventry's immediately moving to dismiss the class claims and moving for summary judgment on the named plaintiff's individual claims the plaintiff moved to dismiss, with prejudice.
Hoda v. Coventry Health Care, Inc. - Representation of Coventry Health Care, Inc., in another purported nationwide class action alleging substantially the same claims as those asserted in Hoda v. Coventry Health Care, Inc., but filed in a differenct federal District Court. Coventry moved to dismiss the class claims and moved for summary judgment before any discovery based upon the interpretation of the contract alleged by the plaintiff. The motions are pending.
Chehalem Physical Therapy, Inc. v. Coventry Health Care, Inc. - Representation of Coventry Health Care of Georgia, Inc., in claim that an independent insurance agent defrauded the plaintiff in connection with the marketing of a Medicare Advantage plan. The plaintiff voluntarily dismissed her claim while Coventry's motion for summary judgment was pending. (Prior to joining Robins, Kaplan, Miller & Ciresi L.L.P.)
Hewett v. Pineview Health Care Center, et al.
Other In-House Professionals
Our firm has an in-house support team of highly skilled individuals to assist our attorneys in providing the most creative and effective solutions for our clients. Our Forensic Financial and Economic Consultants are comprised of legal financial analysts and a forensic accountant. They handle a variety of financial, economic, accounting, and other quantitative issues and analyses to assist our litigation attorneys and clients. Our Science Advisor Group is comprised of Ph.D. scientists and a research analyst. They assist in all types of litigation, concentrating in the area of patent and science litigation.
Our in-house trial technology consultants provide assistance in a wide assortment of projects to present information both inside and outside of the courtroom. We also have in-house Electronic Data Discovery consultants who coordinate e-discovery projects through collection, preservation, processing, and reviewing of data and information. Our Electronic Data Discovery Consultants work with your company's data retention systems, develop culling and privilege filtering protocols, prepare RFPs to electronic discovery vendors and negotiate contracts, review budgets, and assist in strategic planning and set-up of project design.
What You Can Expect From Us
- We will learn your business, products, and industry.
- We will monitor and discuss with you, the rapidly changing regulatory and economic environment that affects your business.
- We will collaborate with you to formulate dispute resolution strategies or other creative solutions that will meet your goals, needs and objectives.
- We will provide efficient, cost-effective representation for you.
- We will be accessible to you and others in your organization as a resource.
Litigation Practices > Health Care Litigation